Complementary therapy: complement or threat to modern medicine?

The placebo effect and homeopathy

BACKGROUND

Like other forms of medicine, including Complementary and Alternative Medicine (CAM), homeopathy elicits expectations in patients. The physician-patient relationship, personal and comprehensive treatment and lack of adverse effects are elements in creating positive expectations. Other elements may be associated with negative expectations.

METHODS

We conducted a systematic literature review on placebo and nocebo effects in acupuncture and homeopathy using Medline.

RESULTS

Findings on the psychophysiological and neuromediating mechanisms of the placebo-nocebo phenomenon are reviewed. Studies of these effects reveal how expectations and unconscious conditioning can be measured by imaging and EEG methods. They result in significant, non-specific therapeutic effects, which may confuse the evaluation of the specific therapeutic effects treatment, hampering selection of the simillimum.

CONCLUSIONS

Directions for future research on non-specific therapeutic effects of homeopathy to improve clinical practice and clinical research are discussed.

Traditional Chinese medicine prevents inflammation in CCl4-related liver injury in mice

Alternative medicines are being increasingly used and investigated in the management of a variety of disorders. Hepatitis is a common indication for the use of alternative therapies but evidence for the efficacy of many compounds is lacking. We have utilized a well-defined model of liver injury to study the efficacy of three herbal products designed to assist in the management of liver disease. Mice were exposed to carbon tetrachloride (CCL4) given intragastrically after they had been pretreated for five days with either saline or one of four doses of silymarin extract or CH100 (a Chinese herbal medicine comprising of 19 herbs) or one of two doses of CH101 (a Chinese herbal preparation designed to reduce fibrosis). Animals were sacrificed 24 hours after receiving CCL4. Liver enzymes and hepatic histology formed the basis for evaluating efficacy of the treatments. Each of the alternative medicines reduced the alanine amino transferase (ALT) elevation demonstrated after CCL4 injection. The high dose CH100 regimen was most effective in protecting against injury and this was confirmed with hepatic histology. Other doses of CH100, CH101 and silymarin were not shown to provide protection against the histological damage. In conclusion, Silymarin, CH100 and CH101 are able to reduce ALT elevation in animals exposed to CCL4. High dose CH100 provides protection from hepatocyte necrosis in this model. The data add to our understanding of the capacity some herbal medicines have to modify the reaction of the liver to a variety of insults and suggest the value of studying these agents further in human liver diseases.

Developing a measure of attitudes: the holistic complementary and alternative medicine questionnaire

We have developed an 11-item scale, the Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ). Six of the HCAMQ items relate to beliefs about the scientific validity of complementary and alternative medicine (CAM), and five to beliefs about holistic health (HH). The HCAMQ was completed by 50 patients attending a CAM clinic and 50 attending rheumatology outpatients; the former completed it twice. Factor analysis (oblique rotation) showed that the CAM and HH items measured distinct but related constructs. The HCAMQ has good test retest reliability (r=0.86, 0.82 and 0.77 for the total, CAM subscale and HH subscale, respectively). The individuals attending CAM clinics were significantly more positive on the CAM but not the HH subscale of the HCAMQ and also used less antibiotics than those attending rheumatology outpatients. Positivity towards CAM on the total HCAMQ and subscales was significantly associated with lower age, increased vitamin use, reduced painkiller use, and, other than on the HH subscale, less antibiotic use. The reason why the HH subscale failed to distinguish between the two patient groups or predict less antibiotic use is unknown. The HCAMQ appears to have good internal validity, but its external validity remains to be established.

Complementary medicine in Israel

In recent years, the status of complementary medicine in Israel has appeared frequently on the public agenda. The debates and the newspaper headlines concerned with this subject usually deal with legal aspects of the subject, including the relation between complementary medicine and the medical establishment. With the enactment in 1995 of the Compulsory Health Insurance Law, debate over the issue intensified, with the public divided over any proposal to make complementary medicine part of the services guaranteed by law. This paper addresses the current status of complementary medicine in Israel, describes the introduction of complementary medicine to Israel, attitudes toward it of both consumers and medical professionals, and the question of its legal status. While no comprehensive survey describing all aspects of this subject in Israel has yet been undertaken, this paper is based on a survey of the professional literature in Israel, especially that of the Israeli scientific-medical community, a survey of the general press, and an analysis of the health insurance law and its position with respect to the complementary medicine.

Direct integrative practice, time constraints and reactive strategy: an examination of GP therapists' perceptions of their complementary medicine

There has been a movement towards integrating complementary and alternative medicine (CAM) into the NHS and a growing number of general practitioners (GPs) are personally practising CAM to treat their NHS patients (direct integrative practice). While research has begun to examine DIP, time constraints and related issues--of importance not only to practitioners but also to those purchasing and planning health care--have not yet received in depth attention. In response this paper examines GP therapists' experiences of the clinical reality of their DIP. The analysis reveals how a lack of time is perceived by GP therapists as a serious constraint upon their CAM practice and also how they employ a number of strategies in an attempt to overcome such difficulties.

Medicine 2000 years ago: the case of Qumran and other biblical sites

Since the eighteenth century, the dominance of orthodox or allopathic medicine in the West led to the branding of other forms of medicine as alternative. However, research shows a narrowing in the gap in popularity of the two methods and it is possible to envision a time when alternative medicine and mainstream medicine will work in tandem. As the West completes a year of millennium celebrations and looks back to the events that shaped the founding of the first millennium two thousand years ago, it is appropriate to increase our understanding of the form medicine took at that time. Research on Qumran and other biblical sites shows that the therapies offered there were based on alternative therapies such as herbal medicine and hydrotherapy as well as conventional therapy such as surgery. The article shows that the twin reliance on alternative and orthodox methods emerging today, marks a return to a pattern of provision which prevailed at the time the first millennium was born.