​In the February 2025 issue of the Journal of Family Medicine and Primary Care, the Case Series «An audit of 12 cases of long COVID following the lightning process intervention examining benefits and harms» was published.

A lot can be said about the article. My first reaction though, was the use of the term «audit». On February 25th 2025 I sent an email to the editorial office:

Dear Dr. Raman Kumar,

Reference is made to the publication of the article Arroll, Bruce; Moir, Fiona; Jenkins, Eloise; Menkes, David Benjamin. An audit of 12 cases of long COVID following the lightning process intervention examining benefits and harms. Journal of Family Medicine and Primary Care 14(2):p 796-799, February 2025. | DOI: 10.4103/jfmpc.jfmpc_1049_24

According to the authors, they «aimed to conduct an independent, university-based audit on the first long COVID patients treated by the only full-time LP practitioner in New Zealand, …”.

The method is described as “a retrospective, cross-sectional audit”. Readers are informed that “Ethics approval is not required in New Zealand for audits of clinical practice.”.

This gives the impression that the article is a report from an audit of a clinical practice.

I regret to inform you that this is not the case.

A Clinical audit is a part of a continuous quality improvement process. It consists in measuring a clinical outcome or a process against well-defined standards, established using the principles of evidence-based medicine. The comparison between clinical practice and standards leads to the formulation of strategies, in order to improve daily care quality.

“Audit” is a Latin word, and the verb audio (‘hear’) indicates both active listening and the action of investigation and interrogation of the judiciary. Transferred to the English vocabulary “audit” takes on a meaning of “an official inspection of an organization’s accounts, typically by an independent body”.

The term is referring to procedures aiming to ensure that the activities carried out for a purpose are consistent and effective for the achievement of objectives. Clinical (or medical) audits are part of the continuous quality improvement process that focus on specific issues or aspects of health care and clinical practice.

They consist of measuring a clinical outcome or a process, against well-defined standards set on the principles of evidence-based medicine. The aim of an audit is to highlight the discrepancies between actual practice and standard in order to identify the changes needed to improve the quality of care. A peculiar characteristic of the clinical audit is the “professionalism” of the initiative, which is expressed by some typical ingredients: clinical specific competence of the participants, the confidentiality of the results, the object strongly connected to the “quality” of professionals. From a methodological point of view, clinical audit consists of a “quality loop”: once chosen a topic and set shared and measurable criteria and standards, current clinical practice is evaluated, especially in terms of process or outcome, and suggestions for improvement are developed and applied, and then the cycle can begin again.

An audit should not be confused with data collection activities or clinical research.

Reference: Esposito P, Dal Canton A. Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology. World J Nephrol. 2014 Nov 6;3(4):249-55. doi: 10.5527/wjn.v3.i4.249. https://www.wjgnet.com/2220-6124/full/v3/i4/249.htm

I trust that you will ensure that the error is corrected thus upholding the integrity of your journal.

Kind regards,

Nina E. Steinkopf

Former HSEQ Chief Executive

Now; ME patient and writer at melivet.com»

To be continued.

See more information about the Lightning Process here: Quackery against ME in New Zealand