In search of the reliable repertory

Towards improving the reporting quality of clinical case reports in complementary medicine: assessing and illustrating the need for guideline development

BACKGROUND

Case reports have had a varying level of recognition as a source of evidence throughout the history of medicine. In recent years, there has been a revival of interest in clinical case reports in both conventional and complementary medicine. There is a need to further improve the reporting quality of clinical case reports of different Complementary and Alternative Medicine (CAM) therapies.

OBJECTIVES

To provide an overview of the different objectives for clinical case reports, identify those that are most relevant for CAM, and to develop a conceptual framework for purpose orientated clinical case reporting guidelines for CAM therapies. To practically illustrate the chosen approach by developing a clinical case reporting guideline for homeopathic cases.

METHODS

The various objectives of clinical case reports were described by Prof. Milos Jenicek, and the potential relevance of these objectives for CAM were discussed and graded by a mixed panel of experts. A conceptual framework for developing clinical case reporting guidelines for CAM treatments with specific objectives is proposed. The aim is to integrate both 'generic' and 'CAM therapy specific' quality items. This framework has been practically applied to the development of a reporting guideline for clinical case reports in homoeopathy which will be reported in a second article.

RESULTS

An overview is given of the clinical case reporting literature. The conceptual framework for the development of purpose orientated CAM clinical case reporting guidelines is presented. This framework is based on alignment with the recently published 'generic' CARE guideline for reporting of clinical case reports, whilst addressing the CAM specific elements at the same time.

CONCLUSIONS

The scope and importance of clinical case reporting guideline development in CAM is illustrated. A conceptual framework for developing CAM specific clinical case reporting guidelines was established. It has been implemented using homoeopathy as an illustration, and this will be reported in a separate article. Further improvements in clinical case reporting in CAM will greatly contribute to CAM research and education, as well as to improved patient care.

No fear of ghosts in Lycopodium: a contribution to the discussion on repertory reliability

BACKGROUND

Repertory mistakes in modern homeopathy have been pointed out since the early years after the publication of the sixth edition of Kent's repertory. A structural error of many current repertories is the use of Kent's repertory as a basic information source. 'Fear of ghosts' is widely considered to be a symptom of Lycopodium clavatum by the homeopathic community.

OBJECTIVES

To demonstrate that the source of 'fear of ghosts' in Lycopodium clavatum was an inaccurate translation, that has been spread by secondary sources and to review Hahnemann's conception and efforts towards a reliable repertory.

RESULTS

The symptom 'fear of ghosts' does not exist in the primary source, being the product of a misunderstanding of the English translation of Hahnemann's original record, 'fear of frightful imaginary images'. Hahnemann's efforts to compile a reliable and complete dictionary of Materia Medica were also briefly presented, as well as Rückert's repertory, which, in addition to collating and classifying symptoms in alphabetical rubrics and sub-rubrics, displayed them completely, as registered in primary sources.

CONCLUSION

The misunderstanding about 'fear of ghosts' in Lycopodium clavatum exemplifies how distant current homeopathic information is from its primary sources and from Hahnemann's ideal of a symptom-lexicon. In spite of its technical limitations, Rückert's repertory, which was strongly recommended by Hahnemann, can be considered as a template for new repertories based on primary sources.