Random Controlled Trials are the worst of medicine

Over at spiked-online there is a debate on the Best and Worst of Medicine.  Unsurprisingly, skeptics have nominated homeopathy as one of the worst, but the sheer volume of messages of support for homeopathy managed to get a nomination for best as well.

The debate for the worst of medicine is due on the 17th July.  A clinician sums up the current fundamentalist scientistic backlash against CAM with a damning criticism of the RCT and of those who narrowly support it:

Randomised Controlled Trials are the worst 28 May 2008

The worst thing to happen to medicine is undoubtedly the Randomised Clinical Trial (RCT) - not for the information it does and doesn’t give us but for the way it has been used by government and tunnel visioned researchers to qualify some ridiculous practices under the heading “Evidence Based Medicine”.

As clinicians we are ‘encouraged’ (read ‘forced’) to ignore our clinical skills and acumen in favor of flow chart diagnosis and prescribing. It is virtually never mentioned how much morbidity and mortality modern medicine directly causes - recent analysis in the USA places iatrogenic problems as the country’s third biggest killer!

In addition we are using medicines on complicated people, often with multiple diagnoses and on a variety of drugs - RCTs are conducted in strict (non-clinical) settings using young, relatively fit and healthy people. I am always flabbergasted at the conclusions drawn from these to ‘inform’ normal clinic practice - the information is barely ever transferable!

The best thing to happen to modern medicine is the shake-up of the rigid paradigm that is now being forced on the ‘establishment’ by hoards of patients and practitioners giving a huge range of complementary practices their attention and confidence.

The narrow-minded view taken by a radical few is that we don’t know how these modalities work, therefore they can’t work. This attitude clearly needs to be counterbalanced by the many hundreds of thousands of people who use these treatments and (RCT be damned) find that they work!

Scientific curiosity, informed by actually hearing what people are saying, is the only way forward. Retire any ‘scientist’ who is not actively demonstrating a flexible and curious approach to investigating these complementary therapies, suspending thier predjudice and bias - after all, is this not the DEFINITION of a real scientist?

Geoff Woodin, UK

Edzard Ernst, take note.

So much homeopathic research evidence should be made widely available ‘for the sake of scientific progression’

Dr Manjir Samanta-Laughton, author of ‘Punk Science’, attended the Scientific Research in Homeopathy Conference hosted by the Complementary Medical Association, held at the University of Westminster on June 18th 2008.

Here are the Complementary Medical Association’s links (some yet to be activated) to the presentations by Dr Alex Tournier, Karin Mont, Dr Rob Verkerk, Oliver Dowding, Claire Haresnape, Dr Lionel Milgrom and Stephen Gordon.

Dr Samanta-Laughtons response to the conference is on her Amazon blog:

“I got invited to the most amazing conference last week as a VIP guest courtesy of Jayney Goddard and the Complementary Medical Association. Well it threw me for a loop! I had no idea there were so many RCT trials and evidence of homeopathy. Or that there were real scientific investigations into the actual mechanisms of homeopathy as eloquently demonstrated by Dr Lionel Milgrom, a Fellow of the Royal Society of Chemists. As this was the inaugural conference of its kind, I have one question - where have you been all my life? Why has this information been so hard to find? For the sake of scientific progression, this sort of information should be widely available.”

As she says in ‘Punk Science’: “The paradigm of science has come to a grinding halt. Some are complaining that there are no big discoveries to find. Although technology advances at a rapid pace, these are simply improvements on previous discoveries. There have been no radical changes in the way we see the universe for decades…until now!  The time is right for a change in science; for the next big discovery. This revolution will place consciousness at the very heart of an intelligent universe.”

Homeopathy works - more scientific investigation merited

The Daily Mail reports:

“Homeopathy really does work and doctors should recognise its healing effects, say researchers.

A study found that allergy sufferers who were given homeopathic treatment were ten times more likely to be cured than those given a dummy pill instead.

Doctors should be more positive about the alternative medicine, which is the only complementary therapy available on the NHS, the researchers said.

Their study attempts to settle the controversy over homeopathic treatment, which critics say is not effective because of the tiny level of active substance used in most remedies.

It works on the principle that a substance which in large doses will cause the symptoms of an illness can be used in minute doses to relieve the same symptoms.

Critics argue that the active substance is so diluted that homeopathic remedies have no more effect than placebo or dummy treatment.

The study put homeopathy to the test in 50 patients suffering from nasal allergies. They were given either a homeopathic preparation or a placebo.

Each day for four weeks patients recruited from general practices and a hospital in London measured their nasal air flow and recorded symptoms such as blocked, runny or itchy nose, sneezing or eye irritation.

Both groups reported that they got better - but on average patients who received homeopathy had a 28 per cent improvement in nasal air flow compared with 3 per cent among those in the placebo group.

The study was carried out by doctors in Glasgow, led by Dr David Reilly of the Glasgow Homeopathic Hospital, one of five specialist hospitals in Britain. He said the difference in results from the two treatments was statistically significant.

Dr Reilly said this was the fourth trial carried out by his hospital, all with similar results. In addition, there were positive findings in 70 per cent of a further 180 clinical trials.

‘I hope this will encourage doctors to examine the volume of evidence supporting homeopathy - they might be quite surprised at the positive outcome in many trials,’ he said.

He added that it would take consistent scientific investigation to persuade some doctors, but attitudes were changing.

About 20 per cent of doctors in Scotland have basic homeopathic training compared with one per cent 15 years ago.

‘It isn’t just about the remedies, which can be put to the test in trials, but about a greater holistic approach in encouraging self-healing and self-recovery.’”

Dr Bob Leckridge, president of the Faculty of Homeopathy - the body for doctors, vets, nurses and other health professionals - said: ‘This latest research builds on existing evidence that homeopathy works, something that hundreds of doctors and their patients have known for 200 years.’

Homeopathy awareness week - Nelson’s Pharmacy open day

From www.londonisfree.com:

Nelson’s Pharmacy in Mayfair will be offering free mini homeopathic consultations as part of National Homeopathy Awareness Week 2008.

You can benefit from one-to-one drop-in consultations on Saturday 14 June from 10am to 5pm as part of a Homeopathy and Natural Health Open Day when homeopaths will be on hand to provide expert advice on a range of ailments.

Taster sessions of other holistic therapies including massage, health testing and reflexology will also be available at Nelson Homeopathic Pharmacy, along with light refreshments and a free goodie bag.

Find out more about National Homeopathy Awareness Week 2008.

To find out more and book an appointment call 020 7079 1282 or email HAW@nelsons.net.

Edzard Ernst’s uncritical endorsement of EBM is ‘empirical quackery’

Dr Michael Fitzpatrick’s review of the book ’Trick or Treatment’ by Simon Singh and Edzard Ernst at  spiked-online (they say: “an independent online phenomenon dedicated to raising the horizons of humanity by waging a culture war of words against misanthropy, priggishness, prejudice, luddism, illiberalism and irrationalism in all their ancient and modern forms”) makes the following observations and criticisms of interest:

“Despairing of their capacity to engage with serious adversaries or big issues, former left-wingers are inclined to re-fight the battles of the past and to seek out soft targets for their invective: current favourites include neo-fascists, creationists and conservative religionists. Though any small success of these forces is trumpeted as a menace to civilisation, in reality they are as marginal as they have ever been. Exaggerating these threats enables liberals to imagine a return to their glory days, and allows them to evade the real problems of the present.”

“Alternative medicine, the focus of a new critique titled Trick or Treatment? by the science writer Simon Singh and Edzard Ernst, ‘the world’s first professor of complementary medicine’, has become another target of the radical backlash. Following the spectacular success of a series of works promoting militant secularism, a spate of books and blogs now signals a new crusade against alternative medicine.”

“it is light on references”

“My reservations about Trick or Treatment? concern its uncritical endorsement of what the health policy expert Rudolph Klein has characterised as the ‘new scientism’ of ‘evidence-based medicine’ (1), its incoherent advice to doctors on telling the truth and its curiously paternalistic approach towards patients.

According to Singh and Ernst, ‘evidence-based medicine’, a term coined by the epidemiologist David Sackett in 1992, has ‘revolutionised medical practice’. They acknowledge that ‘prior to the development of evidence-based medicine, doctors were spectacularly ineffective’. However, ‘once the medical establishment had adopted such simple ideas as the clinical trial, then progress became swift’. As a result, ‘today’, less than two decades later, according to this remarkable telescoping of the familiar narrative of progress from darkness to enlightenment, ‘the clinical trial is routine in the development of new treatments and medical experts agree that evidence-based medicine is the key to effective health care’.

While it is true that evidence-based medicine (EBM) has made some useful contributions to contemporary medical practice, notably in the systematic use of randomised controlled trials in the study of therapeutic interventions, it is nonsense to claim that it has played a major role in the successes of modern medicine (such as vaccines, antibiotics, steroids, anaesthetics, surgical techniques) which arose from developments in the basic medical sciences.”

“To some of its critics, in its disparagement of theory and its crude number-crunching, EBM marks a return to ‘empiricist quackery’ in medical practice.”

“Why are so many GPs tolerating, promoting or even using bogus treatments?’ is the provocative question posed by Singh and Ernst to my colleagues in primary health care. They consider various possibilities (though they do not seem to apply their commitment to an evidence-based approach to their speculations in this area). Could it be that GPs are simply ignorant of the facts that alternative medicine is useless? They raise the possibility that some GPs may be true believers in alternative therapies, but – understandably – find this too terrifying a subject to investigate further. They believe that many GPs are so inconsiderate towards their patients that this drives them into the sympathetic, empathetic arms of alternative therapists. But for them the most likely explanation is that GPs are simply lazy and respond to their patients’ relentless minor complaints by ‘fobbing them off with placebos’, in the form of ‘bogus remedies’ and referrals to alternative therapists.”

“Singh and Ernst criticise GPs for ‘encouraging patients’ to seek out alternative therapists. In a bizarre parallel with the world of drug addiction, they argue that ‘introducing patients to alternative therapists in relation to a minor condition could act as a gateway to a longer-term reliance’. One taste of a (tasteless) homeopathic pill or twist of an acupuncture needle could lead to a serious habit, and they may end up refusing vaccinations and stopping prescription drugs.

This is getting silly.”

I have received the following further comments from Ralf Jeutter PhD RSHom:

“The quotes from the book presented by Fitzpatrick show how superficial Singh and Ernst’s critique is. It is primarily based on the assumption that EBM is a reliable tool with which to judge treatments, totally ignoring that EBM is far from accepted as that.  Fitzpatrick calls it ‘incoherent advice to doctors’; the ‘founder’ of EBM, Sackett, wrote: ‘EBM … never replaces clinical skills, clinical judgment and clinical experience’, thus refuting in one single sentence everything Ernst claims: that EBM is the most reliable and generally accepted standard for assessing clinical effectiveness.

Ernst is a dramatiser who has lost perspective of real academic/scientific issues when he writes that ‘prior to the development of evidence-based medicine, doctors were spectacularly ineffective.’ If he really means this it is clear that he has an utterly uncritical enthusiasm for what is only the latest fashion in medicine, one that is neither established nor universally accepted. The one appeal it has is its mind numbing simplicity, which totally ignores clinical realities.

The review also highlights how desperate Ernst is to find ANYTHING to discredit CAM: apparently it is habit forming on a par with, well, seriously habit forming things. Rightly Fitzpatrick says: ‘This is silly’.

Ernst loses academic credibility by refusing to acknowledge the real complexity of research into CAM. Moreover he refuses to acknowledge that most conventional treatments and interventions are not evidence based. He has found a way of making headlines by propagating very crude science indeed. His academic status is further undermined by acting much more like a quackbuster of recent years than as somebody who should be encouraging more research (including research methodologies into CAM) to benefit the profession and patients.

It really does not become a Professor of CAM to dismiss such a longstanding and successful practice like homeopathy as ‘bogus’ and ‘nonsense’. As an academic he has had to make a determined effort to ignore the plethora of research which has grown around homeopathy over the last 200 years: pre-clinical fundamental research; fundamental research into physics and chemistry as far as it has a bearing on homeopathy; experiments on plants with ultra-high dilutions; experiments on animals and animal tissue with ultra-high dilutions; in-vitro studies; clinical studies, be they observational or comparative studies; controlled studies of nosological clinical homeopathy to randomised clinical isopathic and epidemiological studies. He has also ignored the dedicated hard work of many researchers into CAM and associated fields: dismissing all of this as useless activity which has yielded nothing and will never yield anything. I think it would suit Prof. Ernst to show more respect to his colleagues and a modicum of modesty.

Ernst has come to the conclusion that homeopathy doesn’t work by cherry-picking what he considers to be state-of-the-art research methodologies, which conflict in many instances with clinical realities.

It appears that it is Ernst’s desire to call a premature end to homeopathy which informs his understanding of ’science’. Homeopathy has survived many fads, fashions and detractors, and will no doubt survive this latest attempt at discrediting it. In my own modest predicition, Ernst, in all likelihood, will become a footnote in the history of homeopathy, like so many before him.  He is an academic who mistakes scientific models with reality.”

‘There is a good and growing body of research showing beyond doubt that homeopathy is better than placebo’

Courtesy of HMC21:

 

There is a good and growing body of research showing beyond doubt that homeopathy is better than placebo; in fact so much, that this leaflet can only provide a minute selection. There is a list of sources of further, detailed information at the end of the summary. Different types of research have been used to study effectiveness of homeopathic remedies, and all have provided positive evidence, although in the case of RCTs not consistently.

 

Laboratory research                                                                         (including tests on animals and plants)

This research is important because there can be no placebo effect, but there are ethical problems when it involves subjecting animals to toxic substances and procedures. We include animal studies here and leave it to you to decide whether you want to use them or not.

·         Belon P, Cumps J, Ennis M, Mannaioni PF, Roberfroid M, Sainte-Laudy J, Wiegant FAC, ‘Histamine dilutions modulate basophil activation’, Inflamm. Res., 2004, 53:181-188. In a study including four research centres in Europe the effect of potentised high dilutions of histamine were confirmed. Researchers were able to document that these dilutions of histamine inhibit basophile degranulation. Results cannot be explained through molecular theories.

·         Brizzi, M. et al., ‘Biostatistical Insight into the As₂O₃ High Dilution Effects on the Rate and Variability of Wheat Seedling Growth’, Forsch Komplementärmed Klass Naturheilkd, 2005,12:277-283. Plant-based bioassays are suitable for basic research - lacking the placebo effect and ensuring large data samples for structured statistical analyses. A team of researchers at the University of Bologna carried out a structured experiment, performed blind over nine weeks, using wheat seeds previously stressed with a sub lethal dose of As₂O₃ (arsenic trioxide). The seeds were then treated with either potentized As₂O₃ (5x, 15x, 25x, 35x, 45x), potentized water (equivalent potencies) or diluted As₂O₃ (10^-5, 10^-15, 10^-25, 10^-35, 10^-45). The working variable was the stem length, measured after 4, 5, 6 and 7 days. Results: Some potencies (As₂O₃ 45x and water 45x) induced a relevant increase in seedling growth and/or a variability decrease. Diluted As₂O₃ did not induce any significant results. Conclusions: Confirmation of a significant stimulating effect on seedling growth and a significant decrease of variability was obtained with ultra-high dilutions at the 45x potency. The model of wheat germination and growth has been confirmed to be a good tool for basic research in homeopathy.

·         J. Bildet, M. Guyot, F. Bonini, et al., ‘Demonstrating the Effects of Apis mellifica and Apium virus Dilutions on Erythema Induced by U.V. Radiation on Guinea Pigs’,  Berlin Journal of Research in Homeopathy, 1990, 1:28. Albino guinea pigs were exposed to small doses of X-ray that cause reddening of the skin. Studies showed that Apis mellifica 7c or 9c had a protective effect and a roughly 50% curative effect on X-ray-induced redness of the skin. Apis mellifica (honeybee) is a homeopathic medicine for redness, swelling, and itching, common symptoms of bee venom.

·         Endler, P.C. et al., ‘The Effect of Highly Diluted Agitated Thyroxine on the Climbing Activity of Frogs’,  Veterinary and Human Toxicology, 1994, 36:56. Thyroxine 30x (thyroid hormone) was placed in the water of tadpoles. When compared to tadpoles who were given a placebo, the study showed morphogenesis of the tadpoles into frogs was slowed for those who were exposed to the homeopathic doses. Thyroid hormone in crude doses is known to speed up morphogenesis; it makes sense from a homeopathic perspective that homeopathic doses would slow it down. See doi:10.1016/j.homp.2007.11.002 at http://dx.doi.org for a further experiment in 2006 which confirmed this research.

 

Meta-analyses                          (the statistical amalgamation, summary, and review of previous quantitative research)

·         Linde, K. et al.,  ‘Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials’, The Lancet, 1997, 350:834-843: Meta-analysis of 89 trials of homeopathic medicine versus placebo. Result: significantly in favour of homeopathy (OR 2,45 (95% CI 2,05-2,93)). This meta-analysis included 186 placebo-controlled studies of homeopathy published until mid-1996, of which data for analysis could be extracted from 89 studies. The main conclusion was that the results “were not compatible with the hypothesis that the effects of homeopathy are completely due to placebo”.

·         Homeopathic Medicine Research Group, Report to the European Commission directorate general XII: science, research and development, vol. 1 (short version), Brussels: European Commission, 1996:16-17. This is an overview of clinical research in homeopathy which identified 184 controlled clinical trials. They selected the highest quality randomized control trials, which included a total of 2617 patients for a meta-analysis. This meta-analysis resulted in a p-value of 0.000036 (which means that results are highly significant) indicating that homeopathy is more effective than placebo. The researchers concluded that the “hypothesis that homeopathy has no effect can be rejected with certainty”.

·         Ullman D, ‘Controlled Clinical Trials Evaluating the Homeopathic Treatment of People with Human Immunodeficiency Virus or Acquired Immune Deficiency Syndrome’, The Journal of Alternative and Complementary Medicine, vol. 9, no. 1, 2003, pp. 133–141. A review of placebo-controlled clinical trials using homeopathic medicines to treat people with AIDS or who are HIV-positive found five controlled clinical trials. Results showed statistically significant results in subjects with stage III AIDS, and specific physical, immunologic, neurologic, metabolic, and quality-of-life benefits, including improvements in lymphocyte counts and functions and reductions in HIV viral loads in patients receiving homeopathic treatment.

 

Randomised Controlled Trials (RCTs)           (where one group of subjects is given the treatment being tested,

                                                                                       while a control group is given either a current treatment or a placebo)

Dozens of individual RCTs have been carried out, sometimes repeatedly, researching the effectiveness of homeopathy for a range of conditions. Many are covered in the meta-analyses discussed above.  See the websites below for details.

 

Non-controlled clinical study             (comparison of new or different types of treatments with current treatments)

·         Witt, C. et al., ‘Outcome and costs of homoeopathic and conventional treatment strategies: A comparative cohort study in patients with chronic disorders’, Complementary Therapies in Medicine, 2005, 13, pp. 79-86. Researchers at the Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Center, Berlin, Germany and the Institute for Statistics and Econometrics, Economics, University of Hamburg, Germany  conducted an evaluation of  the effectiveness of homeopathy versus conventional treatment in routine case. Patients with selected chronic diagnoses received either homeopathy or conventional treatment.  Severity of symptoms was assessed by patients and physicians on a scale of 0 to 10, at baseline, 6 and 12 months; costs were also compared. The analyses of 493 patients (315 adults, 178 children) indicated greater improvement in patients’ assessments after homoeopathic versus conventional treatment (adults: homeopathy from 5.7 to 3.2; conventional from 5.9 to 4.4; p = 0.002; children homeopathy from 5.1 to 2.6; conventional from 4.5 to 3.2). The conclusion was that patients having homeopathic treatment had a better outcome overall compared with patients on conventional treatment, whereas total costs in both groups were similar.

 

Clinical outcome survey              (secondary analysis of data collected routinely by clinical services, in order to

                                                        judge the effectiveness of interventions; allows the study of large databases of patients)

·         Spence DS, Thompson EA, Barron SJ, ‘Homeopathic Treatment for Chronic Disease: A 6-Year, University-Hospital Outpatient Observational Study’, Journal of Alternative and Complementary Medicine, 2005, 11:793-798. In one of the largest studies ever carried out, over 70% of the 6500 patients involved reported significant benefits from homeopathic treatment. The results come from a 6 year study of 6500 consecutive patients seen in the outpatient clinic of the Bristol Homeopathic Hospital in the UK, a UK National Health Service Hospital. Patients with a wide range of conditions such as eczema, asthma, migraine, irritable bowel syndrome, menopause, arthritis, depression and chronic fatigue syndrome were included in the study, all patients having been referred by their General Practitioner or a hospital specialist after unsuccessful conventional treatment.

 

Good Sources of Research Information:

·         Bianci, Prof. Ivo et.al. (2002) Homeopathy: The scientific proofs of its efficacy.  This excellent report has detailed information about many trials and comparative studies, including cost comparisons, and is based on international research. It can be downloaded as an e-book at: http://www.guna.it/eng/ricerca/Homeopathy%20the%20scientific%20proofs%20of%20efficacy.pdf

·         www.homeopathic.com is the website of Dana Ullman’s Homeopathic Educational Services and provides a wealth of good research information.

·         An Overview of Positive Homeopathy Research and Surveys; March 2007. This document has been produced by the European Network of Homeopathy Researchers and can be downloaded from the Research page of the Society of Homeopaths’ website (www.homeopathy-soh.org).

·         www.thehomeopath.org.uk is the website of homeopath Ralf Jeutter PhD RSHom, and has detailed research information.

 

Skeptics are advised to comment on their own blogs. I will accept links. H4H

‘Is an alternative just the tonic?’ Northern Ireland’s ‘Get Well UK’ project

Although Homeopathy is under threat on the mainland, BBC Northern Ireland and The Belfast Telegraph  report on succesful homeopathic treatment in a trial of alternative therapies in two Northern Ireland GP clinics (Get Well UK):

BBC Northern Ireland: “Northern Ireland is said to use more prescription drugs than any other UK region. While tablets may alleviate symptoms, they can be addictive and have side effects. A BBC NI documentary looks at the alternatives:

Londonderry woman Frances Gillen was addicted to prescription drugs for more than 20 years. The legacy of the Troubles and raising five children by herself took its toll. After being caught up in gunfire, she slid into depression and refused to leave home for years.
“
It affected me… I stayed in the house for the guts of three years, or maybe more, without going out. The only place I would have gone to was to go over to the doctors,” she said.  “It got that I would not even wash myself. I got the TV brought up into my room. “I didn’t want to commit suicide but I really didn’t want to go on if this was life, if this was my life… the quicker the better, I could go.

However, her life was turned around when she tried homeopathy as part of a pilot scheme being run in two centres in Northern Ireland.  The Get Well Scheme allowed GPs to refer patients to complementary therapists, with the NHS paying for their treatment.

Within weeks, Frances felt her depression lift and she started to resume normal life; she also came off all prescription medication.

“Now I feel like 16 again… well 30,” she joked.

Belfast Telegraph: “Traditionally Northern Ireland has always used more prescription drugs than anywhere else in the UK. We’re fond of our medicines and we’re fond of going to our doctors. The doctor has always been at the centre of our society. Attitudes, however, are changing and for decades patients are now turning to ancient forms of medicine such as acupuncture and aromatherapy — among other therapies.

In 2006 the government controversially decided to do the same and announced a new initiative — the Get Well Scheme. The trial provided complementary therapies to patients within two health centres in Northern Ireland, the Holywood Arches Health Centre in east Belfast and the Shantallow Health Centre in Londonderry, with the treatment paid for by the NHS.

Its aim was to see if complementary therapies could help the health service be more cost-effective by making patients feel better without the use of expensive prescription drugs.

It was designed to help people with problems such as depression and anxiety.

Then we meet Anne McCloskey, a straight-talking GP from the Shantallow Health Centre whose view on complementary medicine differs but changes over time.

In part, her conversion is due to the case of one remarkable patient featured in the film.

Every GP, Anne McCloskey says, has a set of what is referred to as ‘heart-sink’ patients; those who make the GP’s heart sink as soon as they walk through the door. Some ‘heart-sinks’ will visit their GP as often as every second day and, no matter what the GP does, they continue to decline despite there being no clear cause of sickness.

Dr McCloskey’s ‘heart-sink’ patient was Frances Gillen. For over two decades Frances had been suffering from depression which she says began as a result of ‘Troubles-related’ anxiety coupled by the stress of bringing up a large family.

In the film she recalls an incident in which she was almost hit by gunfire and, as a result, refused to leave the house for a number of years.

Frances became heavily dependent on prescription drugs and was one of the first patients Dr McCloskey referred to the Get Well Scheme and her subsequent story is a success.” 

Homeopathy ‘as effective’ as standard care for eczema

I know it’s been reported on other blogs but I thought I’d include it on mine as well, for completeness sake.

UK GP website Pulse reports:

Homeopathy is as effective as conventional therapy in children with eczema, concludes the first prospective cohort study to compare the treatments.

The German study in 118 children with eczema found conventional treatment by GPs was equally as effective as homeopathic treatment in relieving symptoms and improving quality of life.

Symptom scores, as assessed by patients or their parents at one year, were not significantly different, although physician scores for eczema signs and symptom scores were significantly improved in the homoeopathically treated group.

The authors said this trial in primary care provided good evidence for the use of homeopathy for the treatment of eczema and gave a ‘more realistic picture’ of eczema therapy than that seen in a placebo-controlled randomised controlled trial.”

The research is published in the latest issue of Complementary Therapies in Medicine journal. Which describes itself as:

“Complementary Therapies in Medicine is an international, peer-reviewed journal that has considerable appeal to anyone who seeks objective and critical information on complementary therapies or who wishes to deepen their understanding of these approaches. It will be of particular interest to healthcare practitioners including family practitioners, complementary therapists, nurses, and physiotherapists; to academics including social scientists and CAM researchers; to healthcare managers; and to patients.

Complementary Therapies in Medicine aims to publish valid, relevant and rigorous research and serious discussion articles with the main purpose of improving healthcare. The journal believes that good healthcare needs to be based on clinical judgement and the available evidence on what is safe and effective, integrating conventional and complementary therapies as appropriate.

Complementary Therapies in Medicine publishes a variety of articles including primary research, reviews and opinion pieces. Recognising that some forms of CAM present novel and complex interventions, the journal encourages the exploration of the methodology of research. It believes that researchers should always aim at employing high ethical and methodological standards, and also welcomes small or exploratory studies that make a contribution to the area. Well conducted studies with negative outcomes are also welcome if they inform patient care. The journal welcomes considered opinion pieces that reflect genuine disagreements but remain respectful of the views of others.

Each issue features original, high quality research on complementary medicine, an abstracts sections with details of recently published research of high importance, as well as information and experiences on intregrating complementary medicine into mainstream care.”

Sounds like my kind of journal.

Eighth new homeopathy hospital in Indian state opened by Finance minister

The New India Press reports that more people in the growing Indian economy will benefit from cost-effective homeopathic treatment in the state of Andhra Pradesh:

“TIRUPATI: Finance Minister K Rosaiah inaugurated Positive Homeopathy Clinic here on Monday. It is the eighth homeopathy hospital set up by Dr Manu’s Group in the State.

Speaking on the occasion, Rosaiah said homeopathy was a costeffective system of medicine. The Centre and the State Government are making every effort to promote the Indian systems of medicine.

Ayush is one step in this direction. The State Government launched Rajiv Arogyasri scheme to provide corporate medicare to the poor people. The novel health scheme was appreciated by other states, he said.

The Finance Minister appreciated Positive Homeopathy Hospital chairman Sreekar Manu for setting up the hospital in Tirupati to provide better medicare to people.

Sreekar Manu said the main objective of the hospital was to provide quality medicare to people at an affordable cost. Former Assembly speaker Agarala Eswar Reddy, hospital directors AM Reddy, Kiran Kumar, Tariq Mahmood and others were present.”

As I reported before “Homeopathy is integrated into the general system of health care in India and our study shows that one in ten consumers have consulted a homeopath in the last year.” Global TGI Barometer January 2008 Issue 33

“If there’s little risk, why not exploit the therapy?”

 http://health.usnews.com/blogs/comarow-on-quality/2008/1/9/an-alternative-perspective-on-alternative-medicine.html

“U.S. News’s Avery Comarow has been editor of the America’s Best Hospitals annual rankings since their debut in 1990. In his reporting on all aspects of clinical medicine from the latest cholesterol guidelines to robotic surgery, he has kept one question in the front of his mind: What does this mean to patients? That perspective uniquely qualifies him to observe and comment on the efforts by hospitals and other healthcare providers to improve care and patient safety.”

In his personal blog he reflects on recently reporting on alternative medicine:

“Academic medical centers all over the country—venerable altars of clinical research and practice like Mayo and Duke, top-ranked cancer centers, and even children’s hospitals—are scrambling to roll out therapies that five or 10 years ago most regarded as dubious at best, crackpot at worst. Acupuncture, homeopathy, herbs, traditional Chinese medicine.

When I began my reporting, one of the first things that struck me was that not a single researcher or clinician bothered arguing that the evidence for any of the alternative therapies they were testing and using on patients was persuasive. To the contrary, all agreed that almost none of the studies that show positive results have been designed or run very well.

If I wanted an evidence base, I was out of luck. But absence of evidence, as the late astronomer Carl Sagan said, is not evidence of absence. And if we lack an understanding of or explanation for how something works (as was the case for decades for how an airplane could stay airborne), that doesn’t give us the ammunition to state that it doesn’t work. In philosophy, that kind of reasoning is called argument by ignorance.

The patients I spoke with told me how acupuncture had made their allergies go away, how they were able to avoid painkillers after major surgery because of hypnosis or visualization or other mind-body techniques, how a homeopathic remedy that science would regard simply as water reduced swelling and pain within hours after an injury. I heard many such anecdotes, along with candid appraisals of treatments that seemed to be effective only for a short time or not at all. These people were not all true believers.

It may be that the placebo effect is behind most of the successes claimed for alternative therapies. I suspect it probably is—it can be quite powerful. Suppose we could tap into that power. Maybe we’d need to redefine our thinking about a therapy’s ability to work. What does “work” mean, anyway?

I wrestled with the story for weeks, because those patients made a considerable impact on me. Yes, I’m still an evidence guy. I still want well-done clinical trials to be the foundation for care. I still want researchers to set high standards and to meet them before claiming success. But we’ve been learning some amazing things in recent years about the way the mind affects the body and the body affects the mind, discovering a relationship far more dynamic and interlocked than anyone previously believed. It seems as though many alternative therapies may exploit this relationship. If there’s little risk, why not exploit the therapy?”