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Tournier AL, Bonamin LV, Buchheim-Schmidt S, Cartwright S, Dombrowsky C, Doesburg P, Holandino C, Kokornaczyk MO, van de Kraats EB, López-Carvallo JA, Nandy P, Mazón-Suástegui JM, Mirzajani F, Poitevin B, Scherr C, Thieves K, Würtenberger S, Baumgartner S. Scientific guidelines for preclinical research on potentised preparations manufactured according to current pharmacopoeias-the PrePoP guidelines. JOURNAL OF INTEGRATIVE MEDICINE 2024:S2095-4964(24)00341-8. [PMID: 39013752 DOI: 10.1016/j.joim.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 05/15/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE Pharmacopoeias regulate the manufacture of potentised pharmaceutical preparations used in different branches of complementary and integrative medicine. The physicochemical properties and biological activity of these preparations are often investigated in preclinical research, yet no guidelines for experimental research currently exist in this area. The present PrePoP guidelines aim to provide recommendations to promote high-quality, statistically sound, and reproducible preclinical research on potentised preparations. METHODS Input was gathered from researchers nominated by the relevant scientific societies using a simplified Delphi consensus approach covering the most relevant aspects of basic research methodology in the field including appropriate controls, sample preparation and handling, and statistics. After three rounds of feedback, a consensus was finally reached on the most important aspects and considerations for conducting high-quality research on potentised preparations. RESULTS We present a series of recommendations on a range of topics including experimental controls, system stability, blinding and randomisation, environmental influences, and procedures for the preparation of potentised samples and controls, and we address some specific challenges of this research field. CONCLUSION This expert consensus process resulted in a robust set of methodological guidelines for research on potentised preparations and provides a valuable framework that will inform and improve the quality of subsequent research in this emerging field. PLEASE CITE THIS ARTICLE AS Tournier AL, Bonamin LV, Buchheim-Schmidt S, Cartwright S, Dombrowsky C, Doesburg P, Holandino C, Kokornaczyk MO, van de Kraats EB, López-Carvallo JA, Nandy P, Mazón-Suástegui JM, Mirzajani F, Poitevin B, Scherr C, Thieves K, Würtenberger S, Baumgartner S. Scientific guidelines for preclinical research on potentised preparations manufactured according to current pharmacopoeias-the PrePoP guidelines. J Integr Med. 2024; Epub ahead of print.
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Affiliation(s)
- Alexander L Tournier
- Institute of Complementary and Integrative Medicine, University of Bern, 3010 Bern, Bern, Switzerland; Institute of Integrative Medicine, Witten/Herdecke University, 58455 Witten, North Rhine-Westphalia, Germany; Homeopathy Research Institute, London SW7 4EF, United Kingdom.
| | - Leoni V Bonamin
- Graduate Program on Environmental and Experimental Pathology, Paulista University, São Paulo 01504-000, São Paulo, Brazil
| | - Susann Buchheim-Schmidt
- Department of Medical Science, Deutsche Homöopathie-Union DHU-Arzneimittel GmbH & Co. KG, 76227 Karlsruhe, Baden-Württemberg, Germany
| | - Steven Cartwright
- Cherwell Laboratory for Fundamental Research in Homeopathy, Oxford OX2 8NU, Oxforeshire, United Kingdom
| | - Christoph Dombrowsky
- Institute of Complementary and Integrative Medicine, University of Bern, 3010 Bern, Bern, Switzerland
| | - Paul Doesburg
- Society for Cancer Research, Hiscia Research Institute, 4144 Arlesheim, Basel, Switzerland
| | - Carla Holandino
- Laboratório Multidisciplinar de Ciências Farmacêuticas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Rio de Janeiro, Brazil
| | - Maria Olga Kokornaczyk
- Institute of Complementary and Integrative Medicine, University of Bern, 3010 Bern, Bern, Switzerland; Society for Cancer Research, Hiscia Research Institute, 4144 Arlesheim, Basel, Switzerland
| | | | - Jesús Antonio López-Carvallo
- Departamento de Acuicultura, Facultad de Ciencias del Mar, Universidad Católica del Norte, 1790437 Coquimbo, Elqui, Chile
| | - Papiya Nandy
- Centre for Interdisciplinary Research and Education, Kolkata, West Bengal 700068, West Bengal, India
| | - José Manuel Mazón-Suástegui
- Laboratorio de Homeopatía Acuícola y Semillas Marinas, Centro de Investigaciones Biológicas del Noroeste, La Paz 23096, Baja California Sur, Mexico
| | - Fateme Mirzajani
- Protein Research Center, Shahid Beheshti University, Tehran 1983969411, Iran; Department of Medical Laboratory Science, College of Science, Knowledge University, 44001 Erbil, Erbil, Iraq
| | | | - Claudia Scherr
- Institute of Integrative Medicine, Witten/Herdecke University, 58455 Witten, North Rhine-Westphalia, Germany; Society for Cancer Research, Hiscia Research Institute, 4144 Arlesheim, Basel, Switzerland
| | - Karin Thieves
- Sola Salus, Institute for Homeopathic Research, 52511 Geilenkirchen, North Rhine-Westphalia, Germany
| | | | - Stephan Baumgartner
- Institute of Complementary and Integrative Medicine, University of Bern, 3010 Bern, Bern, Switzerland; Institute of Integrative Medicine, Witten/Herdecke University, 58455 Witten, North Rhine-Westphalia, Germany
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Prusty AK, Bhandari P. A Co-morbid Condition of Warts and Vitiligo Treated with Individualized Homeopathy: An Evidence-Based Case Report. HOMEOPATHY 2021; 111:139-146. [PMID: 34820793 DOI: 10.1055/s-0041-1733975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Whilst warts and vitiligo are both common skin diseases, their co-morbidity is rare. Here we present a clinical case of warts with vitiligo to illustrate the utility of individualized homeopathic treatment. METHOD The homeopathic medicine Sepia officinalis was prescribed, based on individualization. During follow-up, changes were documented by photographs. The non-invasive methods ORIDL (Outcome Related to Impact on Daily Living), VASI (Vitiligo Area and Scoring Index), and VETF (Vitiligo European Task Force) were used to assess treatment progress. Possible causal attribution of outcome with treatment was evaluated using the Modified Naranjo Criteria for Homeopathy (MONARCH). RESULT There was a marked improvement of vitiligo, along with the disappearance of warts, as evidenced photographically. VASI and VETF scores were significantly reduced. Main complaints, as well as overall well-being, improved on the ORIDL scale (+3). The MONARCH score (+9) suggested that the clinical improvement was attributable to the homeopathic intervention. CONCLUSION The study suggests a significant role for individualized homeopathic treatment in the co-morbidity of warts and vitiligo.
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Affiliation(s)
- Akhyaya Kumar Prusty
- Regional Research Institute for Homoeopathy, Puri, Odisha, under Central Council for Research in Homoeopathy, Ministry of AYUSH, Govt. of India, New Delhi, India
| | - Preeti Bhandari
- Regional Research Institute for Homoeopathy, Puri, Odisha, under Central Council for Research in Homoeopathy, Ministry of AYUSH, Govt. of India, New Delhi, India
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Dey S, Shaikh AR, Saha S, Agrawal E, Gautam AK, Karuppusamy A, Sadhukhan S, Dutta S, Ali SS, Basu A, Koley M, Saha S. Efficacy of Individualized Homeopathic Medicines in the Treatment of Atopic Dermatitis in Adults: A Double-Blind, Randomized, Placebo-Controlled, Preliminary Trial. Complement Med Res 2021; 29:17-26. [PMID: 33857943 DOI: 10.1159/000516026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/19/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Individualized homeopathy (IH) in atopic dermatitis (AD) remained under-researched. OBJECTIVE We aimed at evaluating efficacy of IH in AD. METHODS A double-blind, randomized, placebo-controlled, short-term, preliminary trial was conducted in an Indian homeopathy hospital. Patients were randomized to either IH (n = 30) or identical-looking placebo (n = 30) using computerized randomization and allocation. Outcomes were patient-oriented scoring of AD (PO-SCORAD; primary end point), Dermatological Life Quality Index (DLQI) score, and AD burden score for adults (ADBSA; secondary end points), measured monthly for 3 months. An intention-to-treat sample was analyzed after adjusting baseline differences. RESULTS On PO-SCORAD, improvement was higher in IH against placebo, but nonsignificant statistically (pmonth 1 = 0.433, pmonth 2 = 0.442, pmonth 3 = 0.229). Secondary outcomes were also nonsignificant - both DLQI and ADBSA (p > 0.05). Four adverse events (diarrhea, injury, common cold) were recorded. CONCLUSIONS There was a small, but nonsignificant direction of effect towards homeopathy, which renders the trial inconclusive. A properly powered robust trial is indicated.
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Affiliation(s)
- Samit Dey
- Department of Repertory, D.N. De Homoeopathic Medical College and Hospital, Government of West Bengal (affiliated to the West Bengal University of Health Sciences, Government of West Bengal), Kolkata, India
| | - Abdur Rahaman Shaikh
- D.N. De Homoeopathic Medical College and Hospital, Government of West Bengal (affiliated to the West Bengal University of Health Sciences, Government of West Bengal), Kolkata, India
| | - Sangita Saha
- Department of Organon of Medicine and Homoeopathic Philosophy, Calcutta Homoeopathic Medical College and Hospital (affiliated to the West Bengal University of Health Sciences, Government of West Bengal), Kolkata, India
| | - Ekta Agrawal
- Department. of Repertory, National Institute of Homoeopathy, Ministry of AYUSH, Government of India (affiliated to the West Bengal University of Health Sciences, Government of West Bengal), Kolkata, India
| | - Ashish Kumar Gautam
- Department. of Repertory, National Institute of Homoeopathy, Ministry of AYUSH, Government of India (affiliated to the West Bengal University of Health Sciences, Government of West Bengal), Kolkata, India
| | - Avaranjika Karuppusamy
- Department of Materia Medica, National Institute of Homoeopathy, Ministry of AYUSH, Government of India (affiliated to the West Bengal University of Health Sciences, Government of West Bengal), Kolkata, India
| | - Satarupa Sadhukhan
- Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Ministry of AYUSH, Government of India (affiliated to the West Bengal University of Health Sciences, Government of West Bengal), Kolkata, India
| | - Souvik Dutta
- Department of Organon of Medicine and Homoeopathic Philosophy, D.N. De Homoeopathic Medical College and Hospital, Government of West Bengal (affiliated to the West Bengal University of Health Sciences, Government of West Bengal), Kolkata, India
| | - Sk Swaif Ali
- Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Government of West Bengal (affiliated to the West Bengal University of Health Sciences, Government of West Bengal), Howrah, India
| | - Anamika Basu
- Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Government of West Bengal (affiliated to the West Bengal University of Health Sciences, Government of West Bengal), Howrah, India
| | - Munmun Koley
- Department of Organon of Medicine and Homoeopathic Philosophy, State National Homoeopathic Medical College and Hospital, Lucknow, India
| | - Subhranil Saha
- Department of Organon of Medicine and Homoeopathic Philosophy, D.N. De Homoeopathic Medical College and Hospital, Government of West Bengal (affiliated to the West Bengal University of Health Sciences, Government of West Bengal), Kolkata, India,
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Adverse effects in homeopathy. A systematic review and meta-analysis of observational studies. Explore (NY) 2020; 18:114-128. [DOI: 10.1016/j.explore.2020.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/16/2020] [Accepted: 11/21/2020] [Indexed: 11/23/2022]
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Ijaz N. Paradigm-Specific Risk Conceptions, Patient Safety, and the Regulation of Traditional and Complementary Medicine Practitioners: The Case of Homeopathy in Ontario, Canada. FRONTIERS IN SOCIOLOGY 2020; 4:89. [PMID: 33869409 PMCID: PMC8022581 DOI: 10.3389/fsoc.2019.00089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/26/2019] [Indexed: 06/12/2023]
Abstract
While the principle of risk reduction increasingly underpins health professional regulatory models across the globe, concepts of risk are neither static nor epistemically neutral. Conventional biomedicine's risk conceptions are substantially rooted in principles of scientific materialism, while many traditional and complementary medicine systems have vitalistic epistemic underpinnings that give rise to distinctive safety considerations. The statutory regulation of traditional and complementary medicine providers has been identified by the World Health Organization as a strategy for enhancing public safety. However, complex risk-related questions arise at the intersection of medical epistemologies whose concepts are at best overlapping, and at worst incommensurable. Elaborating a theoretical concept of "paradigm-specific risk conceptions," this work employs Bacchi's poststructural mode of policy analysis ("What's the Problem Represented to Be?") to critically analyze risk discourse in government documents pertaining to the 2015 statutory regulation of homeopathic practitioners in Ontario, Canada. The Ontario government's pre-regulatory risk assessments of the homeopathic occupation discursively emphasized cultural safety principles alongside homeopathy-specific risk conceptions. These paradigm-specific concepts, rooted in homeopathy's epistemic vitalism, extend beyond materialist constructions of adverse events and clinical omission to address potential harms from homeopathic "proving symptoms", "aggravation," and "disruption," all considered implausible from a biomedical standpoint. Although the province's new homeopathy regulator subsequently articulated safety competencies addressing such vitalistic concepts, the tangible risk management strategies ultimately mandated for practitioners exclusively addressed risks consistent with the scientific materialist paradigm. This policy approach substantially echoes the implicit biomedical underpinnings evident in Ontario's broader legislative context, but leaves a significant policy gap regarding the primary safety considerations originally articulated as substantiation for homeopathy's statutory regulation. To optimally preserve patient safety and full informed consent, regulators of traditional and complementary medicine professionals should favor a pragmatic, epistemically-inclusive approach that actively negotiates paradigm-specific risk conceptions from both biomedicine and the occupation under governance.
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Viksveen P, Relton C. Depressed patients’ experiences with and perspectives on treatment provided by homeopaths. A qualitative interview study embedded in a trial. Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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van Haselen R. Homeopathic clinical case reports: Development of a supplement (HOM-CASE) to the CARE clinical case reporting guideline. Complement Ther Med 2016; 25:78-85. [DOI: 10.1016/j.ctim.2015.12.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 12/13/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022] Open
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Walach H. Die Zukunft der Homöopathie. Complement Med Res 2016; 23:212-4. [DOI: 10.1159/000448970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Stub T, Musial F, Quandt SA, Arcury TA, Salamonsen A, Kristoffersen A, Berntsen G. Mapping the risk perception and communication gap between different professions of healthcare providers in cancer care: a cross-sectional protocol. BMJ Open 2015; 5:e008236. [PMID: 26338839 PMCID: PMC4563259 DOI: 10.1136/bmjopen-2015-008236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Studies show that patients with cancer who use complementary and alternative medicine (CAM) have a poorer survival prognosis than those who do not. It remains unclear whether this is due to a priori poorer prognosis that makes patients turn to CAM, or whether there is a factor associated with CAM use itself that influences the prognosis negatively. Healthcare providers should assist patients in safeguarding their treatment decision. However, the current non-communication between CAM and conventional providers leaves it up to the patients themselves to choose how to best integrate the two worlds of therapy. In this study, an interactive shared decision-making (SDM) tool will be developed to enable patients and health professionals to make safe health choices. METHODS AND ANALYSIS We will delineate, compare and evaluate perception and clinical experience of communication of risk situations among oncology experts, general practitioners and CAM practitioners. To accomplish this, we will develop a pilot and implement a large-scale survey among the aforementioned health professionals in Norway. Guided by the survey results, we will develop a β-version of a shared decision-making tool for healthcare providers to use in guiding patients to make safe CAM decisions. ETHICS AND DISSEMINATION Participants must give their informed and written consent before inclusion. They will be informed about the opportunity to drop out from the study followed by deletion of all data registered. The study needs no approval from The Regional Committee for Medical and Health Research Ethics because all participants are healthcare professionals. Results from this study will be disseminated in peer-reviewed medical journals.
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Affiliation(s)
- Trine Stub
- Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Frauke Musial
- Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway
| | - Sara A Quandt
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Anita Salamonsen
- Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway
| | - Agnete Kristoffersen
- Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway
| | - Gro Berntsen
- Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway
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Stub T, Kristoffersen AE, Alræk T, Musial F, Steinsbekk A. Risk in homeopathy: Classification of adverse events and homeopathic aggravations--A cross sectional study among Norwegian homeopath patients. Complement Ther Med 2015; 23:535-43. [PMID: 26275646 DOI: 10.1016/j.ctim.2015.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 06/04/2015] [Accepted: 06/04/2015] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED The registration of adverse events is important to identify treatment that might impose risk to patients. Homeopathic aggravation, a concept unique for homeopathy may impose a particular risk, as it is tolerant towards a worsening of the patients' symptoms. The aim of this study was to explore the classification of patient reported reactions as homeopathic aggravations or adverse drug reactions. DESIGN AND SETTING In a cross sectional survey, patients were asked to register any reactions they had experienced 14 days after taking homeopathic remedies. Worsening of symptoms was classified as homeopathic aggravation if it was (i) an increase of the patients' existing symptoms (ii) and/or a feeling of well-being that emerged 1-3 days after taking the remedy (iii) and/or headache and/or fatigue accompanying these symptoms. RESULTS A total of 26% of the participants reported worsening of symptoms. One third was classified as adverse events. Half of these were graded as minor and the other half as moderate according to the Common Terminology Criteria for Adverse Events. Two thirds were classified as homeopathic aggravations. Of these, 73% were classified as minor and 27% as moderate, giving a tendency towards milder severity for those classified as homeopathic aggravations (p=0.065). CONCLUSION Patients reported a substantial part of the short-term reactions after taking homeopathic remedy as a worsening of symptoms. These reactions were classified as mild and moderate. Hence, the risk connected to homeopathic treatment is minor. More studies are needed to confirm the existence of homeopathic aggravation and how to classify the concept in a clinically meaningful way.
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Affiliation(s)
- Trine Stub
- The National Research Center in Complementary and Alternative Medicine (NAFKAM) Department of Community Medicine, Faculty of Health Science, UiT The Arctic University of Norway, 9037 Tromsø, Norway.
| | - Agnete E Kristoffersen
- The National Research Center in Complementary and Alternative Medicine (NAFKAM) Department of Community Medicine, Faculty of Health Science, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Terje Alræk
- The National Research Center in Complementary and Alternative Medicine (NAFKAM) Department of Community Medicine, Faculty of Health Science, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Frauke Musial
- The National Research Center in Complementary and Alternative Medicine (NAFKAM) Department of Community Medicine, Faculty of Health Science, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Aslak Steinsbekk
- Norwegian University of Science and Technology, Department of Public Health and General Practice, Trondheim, Norway
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Stub T, Salamonsen A, Kristoffersen A, Musial F. How to handle worsening of condition during treatment - risk assessment in homeopathic practice. Complement Med Res 2015; 22:30-5. [PMID: 25824402 DOI: 10.1159/000377644] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Even though homeopathy is regarded as a harmless intervention, homeopathic practice may not be entirely risk-free. Risk in homeopathy can be divided into direct and indirect risk. Direct risk refers to traditional adverse effects of an intervention; indirect risk is related to adverse effects in a treatment context, e.g. the practitioner. Available data suggest that the risk profile of homeopathic remedies in ultra-molecular potencies is minor, but there is a potential for indirect risk related to homeopathic practice. The concept of 'homeopathic aggravation' which is unique for homeopathy may impose a particular risk as it allows the health status of the patients to deteriorate before there is a possible improvement. In that respect it is imperative to distinguish homeopathic aggravations from adverse effects. In a general risk evaluation of the homeopathic treatment it may be useful to assess the patient's symptoms in accordance with the natural course of disease and to evaluate any negative deviation from the normal curve as a possible adverse effect of the treatment. It is imperative that more emphasis is placed on patient safety during the education in homeopathy, and that students are trained to identify serious and red flag situations.
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Affiliation(s)
- Trine Stub
- The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT The Arctic University of Norway, Tromsø, Norway
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van Haselen RA. Towards improving the reporting quality of clinical case reports in complementary medicine: assessing and illustrating the need for guideline development. Complement Ther Med 2015; 23:141-8. [PMID: 25847551 DOI: 10.1016/j.ctim.2015.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/12/2014] [Accepted: 01/09/2015] [Indexed: 12/27/2022] Open
Abstract
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.
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Affiliation(s)
- R A van Haselen
- International Institute for Integrated Medicine, 22 Eden Street, Suite 467, Kingston KT1 1DN, United Kingdom.
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White A, Boon H, Alraek T, Lewith G, Liu JP, Norheim AJ, Steinsbekk A, Yamashita H, Fønnebø V. Reducing the risk of complementary and alternative medicine (CAM): Challenges and priorities. Eur J Integr Med 2014. [DOI: 10.1016/j.eujim.2013.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Testing the nanoparticle-allostatic cross-adaptation-sensitization model for homeopathic remedy effects. HOMEOPATHY 2013; 102:66-81. [PMID: 23290882 DOI: 10.1016/j.homp.2012.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 10/25/2012] [Accepted: 10/25/2012] [Indexed: 02/08/2023]
Abstract
Key concepts of the Nanoparticle-Allostatic Cross-Adaptation-Sensitization (NPCAS) Model for the action of homeopathic remedies in living systems include source nanoparticles as low level environmental stressors, heterotypic hormesis, cross-adaptation, allostasis (stress response network), time-dependent sensitization with endogenous amplification and bidirectional change, and self-organizing complex adaptive systems. The model accommodates the requirement for measurable physical agents in the remedy (source nanoparticles and/or source adsorbed to silica nanoparticles). Hormetic adaptive responses in the organism, triggered by nanoparticles; bipolar, metaplastic change, dependent on the history of the organism. Clinical matching of the patient's symptom picture, including modalities, to the symptom pattern that the source material can cause (cross-adaptation and cross-sensitization). Evidence for nanoparticle-related quantum macro-entanglement in homeopathic pathogenetic trials. This paper examines research implications of the model, discussing the following hypotheses: Variability in nanoparticle size, morphology, and aggregation affects remedy properties and reproducibility of findings. Homeopathic remedies modulate adaptive allostatic responses, with multiple dynamic short- and long-term effects. Simillimum remedy nanoparticles, as novel mild stressors corresponding to the organism's dysfunction initiate time-dependent cross-sensitization, reversing the direction of dysfunctional reactivity to environmental stressors. The NPCAS model suggests a way forward for systematic research on homeopathy. The central proposition is that homeopathic treatment is a form of nanomedicine acting by modulation of endogenous adaptation and metaplastic amplification processes in the organism to enhance long-term systemic resilience and health.
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Bell IR, Koithan M. A model for homeopathic remedy effects: low dose nanoparticles, allostatic cross-adaptation, and time-dependent sensitization in a complex adaptive system. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 12:191. [PMID: 23088629 PMCID: PMC3570304 DOI: 10.1186/1472-6882-12-191] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 10/19/2012] [Indexed: 01/09/2023]
Abstract
Background This paper proposes a novel model for homeopathic remedy action on living systems. Research indicates that homeopathic remedies (a) contain measurable source and silica nanoparticles heterogeneously dispersed in colloidal solution; (b) act by modulating biological function of the allostatic stress response network (c) evoke biphasic actions on living systems via organism-dependent adaptive and endogenously amplified effects; (d) improve systemic resilience. Discussion The proposed active components of homeopathic remedies are nanoparticles of source substance in water-based colloidal solution, not bulk-form drugs. Nanoparticles have unique biological and physico-chemical properties, including increased catalytic reactivity, protein and DNA adsorption, bioavailability, dose-sparing, electromagnetic, and quantum effects different from bulk-form materials. Trituration and/or liquid succussions during classical remedy preparation create “top-down” nanostructures. Plants can biosynthesize remedy-templated silica nanostructures. Nanoparticles stimulate hormesis, a beneficial low-dose adaptive response. Homeopathic remedies prescribed in low doses spaced intermittently over time act as biological signals that stimulate the organism’s allostatic biological stress response network, evoking nonlinear modulatory, self-organizing change. Potential mechanisms include time-dependent sensitization (TDS), a type of adaptive plasticity/metaplasticity involving progressive amplification of host responses, which reverse direction and oscillate at physiological limits. To mobilize hormesis and TDS, the remedy must be appraised as a salient, but low level, novel threat, stressor, or homeostatic disruption for the whole organism. Silica nanoparticles adsorb remedy source and amplify effects. Properly-timed remedy dosing elicits disease-primed compensatory reversal in direction of maladaptive dynamics of the allostatic network, thus promoting resilience and recovery from disease. Summary Homeopathic remedies are proposed as source nanoparticles that mobilize hormesis and time-dependent sensitization via non-pharmacological effects on specific biological adaptive and amplification mechanisms. The nanoparticle nature of remedies would distinguish them from conventional bulk drugs in structure, morphology, and functional properties. Outcomes would depend upon the ability of the organism to respond to the remedy as a novel stressor or heterotypic biological threat, initiating reversals of cumulative, cross-adapted biological maladaptations underlying disease in the allostatic stress response network. Systemic resilience would improve. This model provides a foundation for theory-driven research on the role of nanomaterials in living systems, mechanisms of homeopathic remedy actions and translational uses in nanomedicine.
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Bell IR, Howerter A, Jackson N, Brooks AJ, Schwartz GE. Multiweek resting EEG cordance change patterns from repeated olfactory activation with two constitutionally salient homeopathic remedies in healthy young adults. J Altern Complement Med 2012; 18:445-53. [PMID: 22594648 DOI: 10.1089/acm.2011.0931] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Electroencephalography (EEG) offers psychophysiologic tools to improve sensitivity for detecting objective effects in complementary and alternative medicine. This current investigation extended prior clinical research studies to evaluate effects of one of two different homeopathic remedies on resting EEG cordance after an olfactory activation protocol on healthy young adults with remedy-relevant, self-perceived characteristics. METHODS Ninety-seven (7) young adults (N=97, mean age 19 years, 55% women) with good self-rated global health and screened for homeopathic constitutional types consistent with one of two remedies (either Sulphur or Pulsatilla) underwent three weekly laboratory sessions. At each visit, subjects had 5-minute resting, eyes-closed EEG recordings before and after a placebo-controlled olfactory activation task with their constitutionally relevant verum remedy. One remedy potency (6c, 12c, or 30c) used per week, was presented in a randomized order over the 3 sessions. Prefrontal resting EEG cordance values at Fp1 and Fp2 were computed from artifact-free 2-minute EEG samples from the presniffing and postsniffing rest periods. Cordance derives from an algorithm that incorporates absolute and relative EEG values. RESULTS The data showed significant two-way oscillatory interactions of remedy by time for ß, α, θ, and δ cordance, controlling for gender and chemical sensitivity. CONCLUSIONS EEG cordance provided a minimally invasive technique for assessing objective nonlinear physiologic effects of two different homeopathic remedies salient to the individuals who received them. Time factors modulated the direction of effects. Given previous evidence of correlations between cordance and single-photon emission computed tomography, these findings encourage additional neuroimaging research on nonlinear psychophysiologic effects of specific homeopathic remedies.
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Affiliation(s)
- Iris R Bell
- Department of Family & Community Medicine, The University of Arizona, College of Medicine, Tucson, AZ 85719, USA.
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Stub T, Alræk T, Salamonsen A. The Red flag! risk assessment among medical homeopaths in Norway: a qualitative study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 12:150. [PMID: 22967054 PMCID: PMC3488491 DOI: 10.1186/1472-6882-12-150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 09/08/2012] [Indexed: 12/04/2022]
Abstract
BACKGROUND Homeopathy is widely used, and many European physicians practice homeopathy in addition to conventional medicine. Adverse effects in homeopathy are not expected by homeopaths due to the negligible quantities of active substances in a remedy. However, we questioned if homeopathic aggravation, which is described as a temporary worsening of existing symptoms following a correct homeopathic remedy, should be regarded as adverse effects or ruled out as desirable events of the treatment. In order to improve knowledge in an unexplored area of patient safety, we explored how medical homeopath discriminate between homeopathic aggravations and adverse effects, and how they assessed patient safety in medical practice. METHOD A qualitative approach was employed using focus group interviews. Two interviews with seven medical homeopaths were performed in Oslo, Norway. The participants practiced homeopathy besides conventional medicine. Qualitative content analysis was used to analyze the text data. The codes were defined before and during the data analysis. RESULTS According to the medical homeopaths, a feeling of well-being may be a criterion to distinguish homeopathic aggravations from adverse effects. There was disagreement among the participants whether or not homeopathic treatment produced adverse effects. However, they agreed when an incorrect remedy was administrated, it may create a disruption or suppressive reaction in the patient. This was not perceived as adverse effects but a possibility to prescribe a new remedy as new symptoms emerge. This study revealed several advantages for the patients as the medical homeopaths looked for dangerous symptoms which may enhance safety. The patient was given time and space, which enabled the practitioner to see the complete picture. A more comprehensive toolkit gave the medical homeopaths a feeling of professionalism. CONCLUSION This explorative study investigated how Medical Homeopaths understood and assessed risk in their clinical practice. A feeling of well-being emerging soon after taking the remedy was the most important criterion for discriminating between Homeopathic Aggravations and Adverse Effects in clinical practice. The Medical Homeopaths used the view of both professions and always looked for red flag situations in the consultation room. They combined knowledge from two treatment systems which may have advantages for the patient. These tentative results deserve further research efforts to improve patient safety among users of homeopathy. For further research we find it important to improve and develop concepts that are unique to homeopathy in order to validate and modernize this medical practice.
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Affiliation(s)
- Trine Stub
- Department of Community Medicine, NAFKAM (The National Research Center in Complementary and Alternative medicine), University of Tromsø, Tromsø, 9037, Norway
| | - Terje Alræk
- Department of Community Medicine, NAFKAM (The National Research Center in Complementary and Alternative medicine), University of Tromsø, Tromsø, 9037, Norway
| | - Anita Salamonsen
- Department of Community Medicine, NAFKAM (The National Research Center in Complementary and Alternative medicine), University of Tromsø, Tromsø, 9037, Norway
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