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Berna FS, Bagot JL. Probabilistic Reasoning in Homeopathy Practice and its Implications for Clinical Research. HOMEOPATHY 2024; 113:167-175. [PMID: 37907242 DOI: 10.1055/s-0043-1775993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
The principle of similitude put forward by Hahnemann has challenging practical consequences in the selection of the right homeopathic medicine for a patient. According to this principle, only the medicines that best fit the totality of the symptoms of a given patient are supposed to really cure: this greatly depends on the homeopath's clinical analysis. In addition, a patient's illness may be more or less curable, depending on the characteristics of the disease. In their daily practice, homeopaths typically apply Bayesian reasoning to deal with uncertainty associated with both medicine and disease. We suggest that clinical research on homeopathy would gain by integrating this kind of prior estimation of (1) the probability of a given medicine being effective for that particular patient and (2) the probability of the patient's disease (or symptoms) being curable. We therefore suggest that future trials of N-of-1 design may gain (1) by testing a small number of "best candidate" medicines (instead of one) for a given patient facing a given disease, and (2) by including careful prior estimations of the probabilities that (a) each selected medicine will be efficient for that patient and (b) the patient's disease will be reversible with the medicine.
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Affiliation(s)
- Fabrice Sébastien Berna
- Université de Strasbourg, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Collège Universitaire de Médecines Intégrative et Complémentaires, Nantes, France
| | - Jean-Lionel Bagot
- Collège Universitaire de Médecines Intégrative et Complémentaires, Nantes, France
- Department of Integrative Medicine, Saint Vincent Hospital Group, Toussaint Hospital, Strasbourg, France
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2
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Fuller J. Demarcating scientific medicine. STUDIES IN HISTORY AND PHILOSOPHY OF SCIENCE 2024; 106:177-185. [PMID: 38996617 DOI: 10.1016/j.shpsa.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 07/14/2024]
Abstract
Scientific medicine and homeopathy are interesting case studies for the ongoing project of demarcating science from pseudoscience. Much of the demarcation literature formulates abstract criteria for demarcating science from pseudoscience generally. In service of a more localist approach to the demarcation problem, I reconstruct a specific demarcating difference, the like comparison criterion, invoked by nineteenth century adherents to an early model of scientific medicine. If it is to remain relevant today, I argue that the like comparison criterion must be updated in our current era of epidemiological, evidence-based medicine to recognize the importance of assessing study bias and mechanistic implausibility in contemporary medical science.
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Affiliation(s)
- Jonathan Fuller
- Department of History and Philosophy of Science, University of Pittsburgh, Cathedral of Learning 1109, Pittsburgh, PA, 15260, USA.
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3
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Jones CMP, Underwood M, Chou R, Schoene M, Sabzwari S, Cavanagh J, Lin CWC. Analgesia for non-specific low back pain. BMJ 2024; 385:e080064. [PMID: 38936847 PMCID: PMC11208989 DOI: 10.1136/bmj-2024-080064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Caitlin M P Jones
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Camperdown NSW, Australia
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK
- University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, USA
| | - Mark Schoene
- Cochrane Collaboration, Back and Neck Review Group, Newbury MA, USA
| | - Saniya Sabzwari
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Chung-Wei Christine Lin
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Camperdown NSW, Australia
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4
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Hoffmeister L, Huebner J, Keinki C, Muenstedt K. Education of non-medical practitioners in Germany-an analysis of course subjects of specialized schools. Wien Med Wochenschr 2024; 174:189-197. [PMID: 34902098 DOI: 10.1007/s10354-021-00896-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022]
Abstract
In Germany, non-medical practitioners (NMPs; in German: Heilpraktiker) offer a broad range of complementary and alternative (CAM) methods. Our aim was to characterize schools for NMPs in Germany in terms of basic (medical) training and advanced education. We found 165 schools for NMPs in a systematic web-based search. As the medical board examination NMPs must take before building a practice exclusively tests their knowledge in conventional medicine, schools hardly include training in CAM methods. Only few schools offered education on CAM methods in their NMP training. Although NMP associations framed requirements for NMP education, 83.0% (137/165) of schools did not meet these requirements. Patients and physicians should be aware of the lack of training and consequent risks, such as harm to the body, delay of necessary treatment, and interaction with conventional drugs. Disestablishing the profession of NMPs might be a reasonable step.
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Affiliation(s)
- Lea Hoffmeister
- Department of Gynecology and Obstetrics, Ortenauklinikum Offenburg, Ebertplatz 12, 77654, Offenburg, Germany
| | - Jutta Huebner
- Department of Internal Medicine, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Christian Keinki
- Department of Internal Medicine, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Karsten Muenstedt
- Department of Gynecology and Obstetrics, Ortenauklinikum Offenburg, Ebertplatz 12, 77654, Offenburg, Germany
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5
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Raghuraman N, White JN, Watson L, Belleï-Rodriguez CÉ, Shafir R, Wang Y, Colloca L. Neuropsychological mechanisms of observational learning in human placebo effects. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06608-7. [PMID: 38743108 DOI: 10.1007/s00213-024-06608-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
Scientific evidence indicates that placebo effects are psychoneurobiological events involving the contribution of distinct central nervous systems and peripheral physiological mechanisms that influence pain perception and other symptoms. Placebo effects can occur without formal conditioning and direct prior experience because crucial information can be acquired through observational learning. Observation of benefits in another person results in placebo effects of a magnitude like those induced by directly experiencing an analgesic benefit. Understanding the psychological mechanisms of observationally induced placebo effects is a complex and multifaceted endeavor. While previous reviews have highlighted various frameworks and models to understand these phenomena, the underlying biological mechanisms have been overlooked. We summarize critically current understanding of its behavioral and neural mechanisms. Understanding the neural mechanisms of hypoalgesia driven by observation can serve as a foundation for future development of novel theoretical and methodological approaches and ultimately, applications.
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Affiliation(s)
- Nandini Raghuraman
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Graduate Program in Life Sciences, Program in Epidemiology and Human Genetics, University of Maryland School of Medicine, Baltimore, MD, USA
- Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, USA
| | - Jewel N White
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, USA
- Graduate Program in Life Sciences, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, USA
| | - Lakota Watson
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Graduate Program in Life Sciences, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, USA
| | | | - Roni Shafir
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, USA
| | - Yang Wang
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
- Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, USA
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA.
- Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, USA.
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA.
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Teixeira MZ. "Homeopathy is not placebo effect": proof of the scientific evidence for homeopathy. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231438. [PMID: 38716949 PMCID: PMC11068375 DOI: 10.1590/1806-9282.20231438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/28/2023] [Indexed: 05/12/2024]
Affiliation(s)
- Marcus Zulian Teixeira
- Universidade de São Paulo, Hospital das Clínicas, Faculty of Medicine, Department of Psychiatry – São Paulo (SP), Brazil
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7
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Leemhuis H, Seifert R. Prescriptions of homeopathic remedies at the expense of the German statutory health insurance from 1985 to 2021: scientific, legal and pharmacoeconomic analysis. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03005-x. [PMID: 38430230 DOI: 10.1007/s00210-024-03005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/09/2024] [Indexed: 03/03/2024]
Abstract
The prescription of homeopathic remedies at the expense of the statutory health insurance (SHI) system in Germany has been criticized for years due to a lack of evidence. Now, on the planned abolition of the reimbursement of homeopathic medicines in Germany, the debate on this topic has been reignited. The aim of this paper is to show the costs and their development over time incurred by homeopathic remedies in the healthcare system from 1985 to 2021. For this purpose, 15 selected homeopathic medicines were chosen from the drug prescription report (Arzneiverordnungsreport) and analyzed with regard to their development of DDD (Defined Daily Dose) using data from the Wissenschaftliches Institut der Ortskrankenkassen (WidO, Scientific Institute of the General Local Health Insurance Funds) and compared with their respective rational pharmacological alternatives. The price comparison was based on the DDD costs and the pharmacy retail price of the smallest packaging in each case. The clinical study situation for the preparations was also analyzed. For this purpose, the clinical studies provided by the manufacturer and those on PubMed were divided into evidence levels and analyzed. In addition, the presentation of homeopathic remedies on company websites, in online pharmacies, in specialist information and package leaflets was analyzed with regard to side effects, interactions, indication, and information on the alleged effect/proof of efficacy. In many media, information on homeopathic medicines remained incomplete, and non-compliance with the Therapeutic Product Advertising Act (Heilmittelwerbegesetz) was noted. Naming of the products if often very suggestive, too. Manufacturers' claims of efficacy go far beyond what can be considered proven in terms of evidence-based medicine and the quality of most clinical studies is poor. Homeopathic remedies are on average significantly more expensive than their rational pharmacological alternatives. Furthermore, DDD costs have continued to rise over the years analyzed. In aggregate, from a pharmacoeconomic, legal, and scientific perspective, abolition of reimbursement of homeopathic medicines in Germany at the expense of the SHI system is well justified.
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Affiliation(s)
- Hauke Leemhuis
- Institute of Pharmacology, Hannover Medical School, Carl-Neuberg-Straße 1, D-30625, Hannover, Germany
| | - Roland Seifert
- Institute of Pharmacology, Hannover Medical School, Carl-Neuberg-Straße 1, D-30625, Hannover, Germany.
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Brulé D, Landau-Halpern B, Nastase V, Zemans M, Mitsakakis N, Boon H. A Randomized Three-Arm Double-Blind Placebo-Controlled Study of Homeopathic Treatment of Children and Youth with Attention-Deficit/Hyperactivity Disorder. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:279-287. [PMID: 37672605 PMCID: PMC10960167 DOI: 10.1089/jicm.2023.0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Objectives: Approximately 30% of children diagnosed with attention-deficit/hyperactivity disorder (ADHD), the most prevalent mental health disorder in children worldwide, do not respond to conventional pharmaceutical treatments. Previous studies of homeopathic treatment for ADHD have been inconclusive. The objectives of this study were to determine if there (a) is an overall effect of homeopathic treatment (homeopathic medicines plus consultation) in the treatment of ADHD; (b) are any specific effects the homeopathic consultation alone in the treatment of ADHD; and (c) are any specific effects of homeopathic medicines in the treatment of ADHD. Design: The design was a randomized double-blind placebo-controlled clinical trial. Setting/Location: Toronto, Canada. Subjects: Children aged 6-16 years diagnosed with ADHD. Interventions: Participants were randomized to one of three arms: Arm 1 (Remedy and Consultation); Arm 2 (Placebo and Consultation); or Arm 3 (Usual Care). Outcome Measures: Primary Outcome was the change of CGI-P T score between baseline and 28 weeks. Results: There was an improvement in ADHD symptoms as measured by the Conner 3 Global Index-Parent T-score in the two groups (Arms 1 and 2) that received consultations with a homeopathic practitioner when compared with the usual care control group (Arm 3). Parents of the children in the study who received homeopathic consultations (Arms 1 and 2) also reported greater coping efficacy compared with those receiving usual care (Arm 3). There was no difference in adverse events among the three study arms. Conclusions: In this study, homeopathic consultations provided over 8 months with the use of homeopathic remedy was associated with a decrease in ADHD symptoms in children aging 6-16 years when compared with usual treatment alone. Children treated with homeopathic consultations and placebo experienced a similar decrease in ADHD symptoms; however, this finding did not reach statistical significance when correcting for multiple comparisons. Homeopathic remedies in and of themselves were not associated with any change in ADHD symptoms. Clinical Trial Registration: This trial was registered on ClinicalTrials.gov; NCT02086864.
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Affiliation(s)
- David Brulé
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Riverdale Homeopathic Clinic, Toronto, Canada
| | | | | | - Marcia Zemans
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Mitsakakis
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Heather Boon
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Roberts ER, Mosley AJ, Tournier AL. Insights from a Decade of 'Cutting Edge Research in Homeopathy'. HOMEOPATHY 2024; 113:1-3. [PMID: 38286345 DOI: 10.1055/s-0043-1777309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
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10
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Rao SS, Manabe N, Karasawa Y, Hasebe Y, Nozawa K, Nakajima A, Fukudo S. Comparative profiles of lubiprostone, linaclotide, and elobixibat for chronic constipation: a systematic literature review with meta-analysis and number needed to treat/harm. BMC Gastroenterol 2024; 24:12. [PMID: 38166671 PMCID: PMC10759335 DOI: 10.1186/s12876-023-03104-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To comprehensively evaluate the efficacy, safety, patient symptoms, and quality-of-life (QoL) of lubiprostone, linaclotide, and elobixibat as treatment for chronic constipation (CC). DESIGN Systematic literature review (SLR) and meta-analysis (MA). Literature searches were conducted on PubMed and Embase using the Ovid platform. METHODS SLR including randomized controlled trials (RCTs) and observational studies was conducted to identify the overall efficacy and safety of lubiprostone, linaclotide, and elobixibat. Thereafter, MA was performed using only RCTs. The number needed to treat (NNT) and number needed to harm (NNH) analyses were additionally conducted. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was efficacy regarding change in spontaneous bowel movements. Secondary outcomes included safety, constipation-related symptoms, and QoL. RESULTS Twenty-four studies met the inclusion criteria for the SLR: 17 RCTs, 4 observational studies, and 3 single-arm trials. Feasibility assessment for the MA resulted in 14 studies available for safety data analysis, and 8 available for efficacy analysis, respectively. Three drugs showed similar efficacy in the MA and NNT analysis. However, the NNH analysis revealed distinct safety profiles: lubiprostone, linaclotide, and elobixibat were linked to the highest risk of nausea, diarrhea, and abdominal pain, respectively. CONCLUSION The current study provides an updated overview of the efficacy, safety, patient symptoms, and QoL of the three drugs with different mechanisms of action for CC treatment.The findings could help physicians adopt an individualized approach for treating patients with CC in clinical practice.
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Affiliation(s)
- Satish S Rao
- Division of Gastroenterology and Hepatology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Yusuke Karasawa
- Medical Affairs, Viatris Pharmaceuticals Japan Inc, Tokyo, Japan.
| | - Yuko Hasebe
- Medical Affairs, Viatris Pharmaceuticals Japan Inc, Tokyo, Japan
| | - Kazutaka Nozawa
- Medical Affairs, Viatris Pharmaceuticals Japan Inc, Tokyo, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shin Fukudo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Gaertner K, Ulbrich-Zürni S, Baumgartner S, Walach H, Frass M, Weiermayer P. Systematic reviews and meta-analyses in Homeopathy: Recommendations for summarising evidence from homeopathic intervention studies (Sum-HomIS recommendations). Complement Ther Med 2023; 79:102999. [PMID: 37898390 DOI: 10.1016/j.ctim.2023.102999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/16/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Mainly due to the use of different inclusion criteria and quality assessments, systematic reviews (SRs) and meta-analyses (MAs) with homeopathic intervention studies (HOMIS) have shown inconsistent results. We aimed to build recommendations for "Summarizing evidence from Homeopathic Intervention Studies" (Sum-HomIS recommendations) in order to approach standardization. METHODS Against the background of a framework-project to update the evidence from homeopathic intervention studies, we launched an expert panel on how to assess the quality of HOMIS and how to summarize evidence from HOMIS. The results of a literature review and the expert communications in advance of the panel as well as the consensus from the discussions are presented here. We added specific considerations for homeopathic veterinary research. RESULTS On top of the general guidelines when planning a review we report five basic Sum-HomIS recommendations. These are: 1) A broad literature search including special archives and consideration of so-called grey-literature; 2) The inclusion of controlled observational studies alongside randomized controlled trials; 3) The choice of a clear clinical research question in the terms that, if possible, the review project includes studies with predominantly homogeneous populations, interventions, comparators and outcomes (PICOs); 4) The use of a global quality assessment including the assessment of external, model and internal validity; 5) A summary of evidence using the GRADE-approach if the body of evidence is sufficiently large and homogenous or a descriptive summary if it is not so. CONCLUSIONS We present recommendations for designing, conducting, and reporting SRs and MAs with HOMIS.
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Affiliation(s)
- Katharina Gaertner
- Institute of Integrative Medicine, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, DE-58313 Herdecke, Germany
| | - Susanne Ulbrich-Zürni
- WissHom: Scientific Society for Homeopathy, Wallstraße 48, DE-06366 Koethen, Germany
| | - Stephan Baumgartner
- Institute of Complementary and Integrative Medicine IKIM, University of Bern, Freiburgstr. 46, CH-3010 Bern, Switzerland
| | - Harald Walach
- Next Society Institute, Kazimieras Simonavicius University, Vilnius, Lituania; Change Health Institute, Berlin, Germany
| | - Michael Frass
- WissHom: Scientific Society for Homeopathy, Wallstraße 48, DE-06366 Koethen, Germany; em. Medical University of Vienna, Department of Medicine I, A-1090 Vienna, Austria; Institute for Homeopathic Research, Columbusgasse 20, A-1100 Vienna, Austria
| | - Petra Weiermayer
- WissHom: Scientific Society for Homeopathy, Wallstraße 48, DE-06366 Koethen, Germany.
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Hamre HJ, Glockmann A, von Ammon K, Riley DS, Kiene H. Efficacy of homoeopathic treatment: Systematic review of meta-analyses of randomised placebo-controlled homoeopathy trials for any indication. Syst Rev 2023; 12:191. [PMID: 37805577 PMCID: PMC10559431 DOI: 10.1186/s13643-023-02313-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 08/08/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Since 1997, several meta-analyses (MAs) of placebo-controlled randomised efficacy trials of homoeopathy for any indication (PRETHAIs) have been published with different methods, results and conclusions. To date, a formal assessment of these MAs has not been performed. The main objective of this systematic review of MAs of PRETHAIs was to evaluate the efficacy of homoeopathic treatment. METHODS The inclusion criteria were as follows: MAs of PRETHAIs in humans; all ages, countries, settings, publication languages; and MAs published from 1 Jan. 1990 to 30 Apr. 2023. The exclusion criteria were as follows: systematic reviews without MAs; MAs restricted to age or gender groups, specific indications, or specific homoeopathic treatments; and MAs that did not assess efficacy. We searched 8 electronic databases up to 14 Dec. 2020, with an update search in 6 databases up to 30 April 2023. The primary outcome was the effect estimate for all included trials in each MA and after restricting the sample to trials with high methodological quality, according to predefined criteria. The risk of bias for each MA was assessed by the ROBIS (Risk Of Bias In Systematic reviews) tool. The quality of evidence was assessed by the GRADE framework. Statistical analyses were performed to determine the proportion of MAs showing a significant positive effect of homoeopathy vs. no significant difference. RESULTS Six MAs were included, covering individualised homoeopathy (I-HOM, n = 2), nonindividualised homoeopathy (NI-HOM, n = 1) and all homoeopathy types (ALL-HOM = I-HOM + NI-HOM, n = 3). The MAs comprised between 16 and 110 trials, and the included trials were published from 1943-2014. The median trial sample size ranged from 45 to 97 patients. The risk of bias (low/unclear/high) was rated as low for three MAs and high for three MAs. Effect estimates for all trials in each MA showed a significant positive effect of homoeopathy compared to placebo (5 of 5 MAs, no data in 1 MA). Sensitivity analyses with sample restriction to high-quality trials were available from 4 MAs; the effect remained significant in 3 of the MAs (2 MAs assessed ALL-HOM, 1 MA assessed I-HOM) and was no longer significant in 1 MA (which assessed NI-HOM). DISCUSSION The quality of evidence for positive effects of homoeopathy beyond placebo (high/moderate/low/very low) was high for I-HOM and moderate for ALL-HOM and NI-HOM. There was no support for the alternative hypothesis of no outcome difference between homoeopathy and placebo. The available MAs of PRETHAIs reveal significant positive effects of homoeopathy beyond placebo. This is in accordance with laboratory experiments showing partially replicable effects of homoeopathically potentised preparations in physico-chemical, in vitro, plant-based and animal-based test systems. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020209661. The protocol for this SR was finalised and submitted on 25 Nov. 2020 and registered on 26 Dec. 2020.
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Affiliation(s)
- H J Hamre
- Institute for Applied Epistemology and Medical Methodology at Witten/Herdecke University (IFAEMM), Freiburg, Germany.
- Faculty of Health, Department of Medicine, Chair of Medical Theory, Integrative and Anthroposophic Medicine, Witten/Herdecke University, Witten, Germany.
| | - A Glockmann
- Institute for Applied Epistemology and Medical Methodology at Witten/Herdecke University (IFAEMM), Freiburg, Germany
| | - K von Ammon
- Faculty of Health, Department of Medicine, Chair of Medical Theory, Integrative and Anthroposophic Medicine, Witten/Herdecke University, Witten, Germany
| | - D S Riley
- Maryland University of Integrative Health (MUIH), Laurel, MD, USA
- Homeopathic Pharmacopoeia Convention of the United States (HPCUS), Southeastern, PA, USA
| | - H Kiene
- Institute for Applied Epistemology and Medical Methodology at Witten/Herdecke University (IFAEMM), Freiburg, Germany
- Faculty of Health, Department of Medicine, Chair of Medical Theory, Integrative and Anthroposophic Medicine, Witten/Herdecke University, Witten, Germany
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13
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Gaertner K, Beer AM, Matthes H, Keusgen M, Frass M, Teut M, Steinmann D, Etter G, Geiger M, Weiermayer P. [Argument for an objective review of the available evidence on homeopathy in rheumatic diseases]. Z Rheumatol 2023; 82:711-713. [PMID: 37792029 DOI: 10.1007/s00393-023-01423-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Katharina Gaertner
- Institut für Integrative Medizin, Universität Witten/Herdecke, Gerhard-Kienle-Weg 4, 58313, Herdecke, Deutschland.
| | - André-Michael Beer
- Klinik für Naturheilkunde, Katholisches Klinikum Bochum, Klinik Blankenstein, Hattingen, Deutschland
| | | | | | - Michael Frass
- Institut für Homöopathieforschung, Wissenschaftliche Gesellschaft für Homöopathie (WissHom), Köthen, Wien, Österreich
| | - Michael Teut
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Diana Steinmann
- Medizinische Hochschule Hannover, Klinik für Strahlentherapie und Spezielle Onkologie, Bereichsleitung Klaus-Bahlsen-Zentrum für Integrative Onkologie am CCC Hannover, Hannover, Deutschland
| | - Gisela Etter
- UNION Schweizerischer komplementärmedizinischer Ärzteorganisationen, Luzern, Schweiz
| | - Michaela Geiger
- Deutscher Zentralverein homöopathischer Ärzte (DZVhÄ), Berlin, Deutschland
| | - Petra Weiermayer
- Wissenschaftliche Gesellschaft für Homöopathie (WissHom), Köthen, Deutschland
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Gaertner K, von Ammon K, Fibert P, Frass M, Frei-Erb M, Klein-Laansma C, Ulbrich-Zuerni S, Weiermayer P. Recommendations in the design and conduction of randomised controlled trials in human and veterinary homeopathic medicine. Complement Ther Med 2023; 76:102961. [PMID: 37393961 DOI: 10.1016/j.ctim.2023.102961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/30/2023] [Accepted: 06/28/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Randomised controlled trials (RCTs) are an established research method to investigate the effects of an intervention. Several recent systematic reviews and meta-analyses of RCTs with homeopathic interventions have identified shortcomings in design, conduct, analysis, and reporting of trials. Guidelines for RCTs in homeopathic medicine are lacking. OBJECTIVES This paper aims to fill this gap in order to enhance the quality of RCTs in the field of homeopathy. METHODS Identification of the homeopathy-specific requirements for RCTs by reviewing literature and experts' communications. Systematization of the findings using a suitable checklist for planning, conducting, and reporting RCTs, namely the SPIRIT statement, and high-quality homeopathy RCTs as examples. Cross-checking of the created checklist with the RedHot-criteria, the PRECIS criteria, and a qualitative evaluation checklist. Consideration of the REFLECT statement and the ARRIVE Guidelines 2.0 for veterinary homeopathy. RESULTS Recommendations for future implementation of RCTs in homeopathy are summarized in a checklist. Alongside, identified useful solutions to the issues encountered when designing and conducting homeopathy RCTs are presented. CONCLUSIONS The formulated recommendations present guidelines additional to those in the SPIRIT checklist, on how to better plan, design, conduct, and report RCTs in homeopathy.
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Affiliation(s)
- Katharina Gaertner
- Institute of Complementary and Integrative Medicine IKIM, University of Bern, Freiburgstr. 46, CH-3010 Bern, Switzerland; Institute of Integrative Medicine, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, DE-58313 Herdecke, Germany
| | - Klaus von Ammon
- Institute of Complementary and Integrative Medicine IKIM, University of Bern, Freiburgstr. 46, CH-3010 Bern, Switzerland
| | - Philippa Fibert
- Department of Psychology and Pedagogic Science, St Mary's University, Twickenham, UK
| | - Michael Frass
- em. Medical University of Vienna, Department of Medicine I, A-1090 Vienna, Austria; Institute for Homeopathic Research, Columbusgasse 20, A-1100 Vienna, Austria
| | - Martin Frei-Erb
- Institute of Complementary and Integrative Medicine IKIM, University of Bern, Freiburgstr. 46, CH-3010 Bern, Switzerland
| | - Christien Klein-Laansma
- Louis Bolk Institute, Health and Nutrition, Kosterijland 3-5, NL-3981 AJ Bunnik, the Netherlands
| | | | - Petra Weiermayer
- WissHom: Scientific Society for Homeopathy, Wallstraße 48, DE-06366 Koethen, Germany.
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15
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Maraud J, Bedhomme S, Pereira B, Trévis S, Jary M, Balayssac D. Self-Medication during and after Cancer: A French Nation-Wide Cross-Sectional Study. Cancers (Basel) 2023; 15:3190. [PMID: 37370800 DOI: 10.3390/cancers15123190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Little data are available in Western countries regarding self-medication practices in the context of cancer. The aim of this study was to describe the prevalence of self-medication practices during (cancer patients) and after cancer (cancer survivors). (2) Methods: This multicenter, cross-sectional, and online study was designed to assess self-medication prevalence. Other objectives were explored, notably the medication types, the perceived risks, and the relation with symptoms and quality of life. (3) Results: Among the 518 patients analyzed, 56.4% declared they practiced self-medication. Dietary supplements and pain medications were used by more than half of the patients. Self-medication was practiced in order to manage the adverse effects of anticancer therapies (63.8%), for which pain was the leading indication (39%), and to improve the efficacy of anticancer therapies (43.8%, cancer patients). Patients believed that self-medication could not lead to drug interactions with anticancer therapies (84.9%, cancer patients), or to adverse effects (84.6%, cancer patients and survivors). Self-medication practices were associated with altered social functioning, pain, insomnia, and financial difficulties. (4) Conclusions: Self-medication was performed by more than half of the responders (ongoing or past cancer) and could be a marker of the undermanagement of cancer and treatment-related adverse effects.
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Affiliation(s)
- Julie Maraud
- UFR de Pharmacie, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Sabrina Bedhomme
- UR ACCePPT, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de la Recherche Clinique et de l'Innovation, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Sophie Trévis
- Pharmacie, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Marine Jary
- Chirurgie et Oncologie Digestive, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - David Balayssac
- UMR1107, NEURO-DOL, INSERM, Direction de la Recherche Clinique et de l'Innovation, Université Clermont Auvergne, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
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16
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Keyßer G, Michalsen A, Reuß-Borst M, Frohne I, Gläß M, Pfeil A, Schultz O, Seifert O, Sander O. [Recommendations of the committee on complementary medicine and nutrition in ayurvedic medicine, homeopathy, nutrition and Mediterranean diet]. Z Rheumatol 2023:10.1007/s00393-023-01356-z. [PMID: 37212842 PMCID: PMC10382356 DOI: 10.1007/s00393-023-01356-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 05/23/2023]
Abstract
Methods of complementary and alternative medicine (CAM) are appealing for many patients with rheumatic diseases. The scientific data are currently characterized by a large number of publications that stand in contrast to a remarkable shortage of valid clinical studies. The applications of CAM procedures are situated in an area of conflict between efforts for an evidence-based medicine and high-quality therapeutic concepts on the one hand and ill-founded or even dubious offers on the other hand. In 2021 the German Society of Rheumatology (DGRh) launched a committee for CAM and nutrition, which aims to collect and to evaluate the current evidence for CAM applications and nutritional medical interventions in rheumatology, in order to elaborate recommendations for the clinical practice. The current article presents recommendations for nutritional interventions in the rheumatological routine for four areas: nutrition, Mediterranean diet, ayurvedic medicine and homeopathy.
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Affiliation(s)
- Gernot Keyßer
- Klinik für Innere Medizin II, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle, Deutschland.
| | - Andreas Michalsen
- Immanuel Krankenhaus Berlin, Königstr. 63, 14109, Berlin-Wannsee, Deutschland
| | - Monika Reuß-Borst
- Facharztpraxis für Innere Medizin, Frankenstr. 36, 97708, Bad Bocklet, Deutschland
| | - Inna Frohne
- Privatpraxis für Rheumatologie, Frankenstr. 238, 45134, Essen, Deutschland
| | - Mandy Gläß
- Helios Fachklinik Vogelsang-Gommern, Sophie-von-Boetticher-Str. 1, 39245, Vogelsang-Gommern, Deutschland
| | - Alexander Pfeil
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - Olaf Schultz
- Rheumazentrum, ACURA Kliniken Baden-Baden, Rotenbachtalstr. 5, 76530, Baden-Baden, Deutschland
| | - Olga Seifert
- Klinik und Poliklinik für Rheumatologie, Universitätsklinikum Leipzig, Liebigstr. 20, Haus 4, 04103, Leipzig, Deutschland
| | - Oliver Sander
- Klinik für Rheumatologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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17
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Zadey S. Yes to pluralistic health system, but no to homeopathy. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 10:100172. [PMID: 37383360 PMCID: PMC10305988 DOI: 10.1016/j.lansea.2023.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/10/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Siddhesh Zadey
- Corresponding author. 215, Bajaj Nagar, Nagpur, Maharashtra 440010, India.
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18
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Aßmann L, Betsch T. Medical decision making beyond evidence: Correlates of belief in complementary and alternative medicine (CAM) and homeopathy. PLoS One 2023; 18:e0284383. [PMID: 37083856 PMCID: PMC10121010 DOI: 10.1371/journal.pone.0284383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/29/2023] [Indexed: 04/22/2023] Open
Abstract
Many people believe in and use complementary and alternative medicine (CAM) to address health issues or prevent diseases. Empirical evidence for those treatments is either lacking or controversial due to methodological weaknesses. Thus, practitioners and patients primarily rely on subjective references rather than credible empirical evidence from systematic research. This study investigated whether cognitive and personality factors explain differences in belief in CAM and homeopathy. We investigated the robustness of 21 predictors when examined together to obtain insights into key determinants of such beliefs in a sample of 599 participants (60% female, 18-81 years). A combination of predictors explained 20% of the variance in CAM belief (predictors: ontological confusions, spiritual epistemology, agreeableness, death anxiety, gender) and approximately 21% of the variance in belief in homeopathy (predictors: ontological confusions, illusory pattern perception, need for cognitive closure, need for cognition, honesty-humility, death anxiety, gender, age). Individuals believing in CAM and homeopathy have cognitive biases and certain individual differences which make them perceive the world differently. Findings are discussed in the context of previous literature and in relation to other unfounded beliefs.
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Affiliation(s)
- Leonie Aßmann
- Department of Psychology, Faculty of Education, University of Erfurt, Erfurt, Germany
| | - Tilmann Betsch
- Department of Psychology, Faculty of Education, University of Erfurt, Erfurt, Germany
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19
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Gaertner K, Loef M, Frass M, Mittal R, Khurana A, Manchanda R, von Ammon K, Frei-Erb M, Walach H, Baumgartner S. Bibliography of Homeopathic Intervention Studies (HOMIS) in Human Diseases. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:14-21. [PMID: 36190509 DOI: 10.1089/jicm.2022.0523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives: Homeopathy (HOM) is a therapeutic method, which is widely used by patients and medical professionals. The medical conditions as well as the homeopathic medical products investigated vary strongly. There is an extensive amount of research, and this necessitates a bibliography that comprehensively presents the entire body of clinical evidence grouped according to medical conditions. Design: Thirty-seven online sources as well as print libraries were searched for HOM and related terms in eight languages (1980 to March 2021). We included studies that compared a homeopathic medicine or intervention with a control regarding the therapeutic or preventive outcome of a disease (classified according to International Classification of Diseases-10). The data were extracted independently by two reviewers and analyzed descriptively. Results: A total of 636 investigations met the inclusion criteria, of which 541 had a therapeutic and 95 a preventive purpose. Seventy-three percent were randomized controlled trials (n = 463), whereas the rest were non-randomized studies (n = 173). The leading comparator was placebo (n = 400). The type of homeopathic intervention was classified as multi-constituent or complex (n = 272), classical or individualized (n = 176), routine or clinical (n = 161) and isopathic (n = 19), or various (n = 8). The potencies ranged from 1X (dilution of -10,000) to 10 M (100-10.000). The included studies explored the effect of HOM in 223 medical indications. We present the evidence in an online database. Conclusions: This bibliography maps the status quo of clinical research in HOM. The data will serve for future targeted reviews, which may focus on the most studied conditions and/or homeopathic medicines, clinical impact, and the risk of bias of the included studies.
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Affiliation(s)
- Katharina Gaertner
- Institute of Integrative Medicine, University of Witten/Herdecke, Herdecke, Germany
| | - Martin Loef
- Change Health Science Institute, Berlin, Germany
| | - Michael Frass
- Institute for Homeopathic Research, Vienna, Austria.,Scientific Society for Homeopathy, Koethen, Germany
| | - Renu Mittal
- Central Council for Research in Homeopathy (CCRH), Ministry of AYUSH, New Delhi, India
| | - Anil Khurana
- Central Council for Research in Homeopathy (CCRH), Ministry of AYUSH, New Delhi, India
| | - Rajkumar Manchanda
- Central Council for Research in Homeopathy (CCRH), Ministry of AYUSH, New Delhi, India
| | - Klaus von Ammon
- Scientific Society for Homeopathy, Koethen, Germany.,Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
| | - Martin Frei-Erb
- Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
| | | | - Stephan Baumgartner
- Institute of Integrative Medicine, University of Witten/Herdecke, Herdecke, Germany.,Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
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20
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Hawke K, King D, van Driel ML, McGuire TM. Homeopathic medicinal products for preventing and treating acute respiratory tract infections in children. Cochrane Database Syst Rev 2022; 12:CD005974. [PMID: 36511520 PMCID: PMC9746041 DOI: 10.1002/14651858.cd005974.pub6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acute respiratory tract infections (ARTIs) are common and may lead to complications. Most children experience between three and six ARTIs annually. Although most infections are self-limiting, symptoms can be distressing. Many treatments are used to control symptoms and shorten illness duration. Most treatments have minimal benefit and may lead to adverse events. Oral homeopathic medicinal products could play a role in childhood ARTI management if evidence for their effectiveness is established. This is an update of a review first published in 2018. OBJECTIVES To assess the effectiveness and safety of oral homeopathic medicinal products compared with placebo or conventional therapy to prevent and treat ARTIs in children. SEARCH METHODS We searched CENTRAL (2022, Issue 3), including the Cochrane Acute Respiratory Infections Specialised Register, MEDLINE (1946 to 16 March 2022), Embase (2010 to 16 March 2022), CINAHL (1981 to 16 March 2022), AMED (1985 to 16 March 2022), CAMbase (searched 16 March 2022), and British Homeopathic Library (searched 26 June 2013 - no longer operating). We also searched the WHO ICTRP and ClinicalTrials.gov (16 March 2022), checked references, and contacted study authors to identify additional studies. SELECTION CRITERIA We included double-blind randomised controlled trials (RCTs) or double-blind cluster-RCTs comparing oral homeopathy medicinal products with identical placebo or self-selected conventional treatments to prevent or treat ARTIs in children aged 0 to 16 years. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS In this 2022 update, we identified three new RCTs involving 251 children, for a total of 11 included RCTs with 1813 children receiving oral homeopathic medicinal products or a control treatment (placebo or conventional treatment) for ARTIs. All studies focused on upper respiratory tract infections (URTIs), with only one study including some lower respiratory tract infections (LRTIs). Six treatment studies examined the effect on URTI recovery, and five studies investigated the effect on preventing URTIs after one to four months of treatment. Two treatment and three prevention studies involved homeopaths individualising treatment. The other studies used predetermined, non-individualised treatments. All studies involved highly diluted homeopathic medicinal products, with dilutions ranging from 1 x 10-4 to 1 x 10-200. We identified several limitations to the included studies, in particular methodological inconsistencies and high attrition rates, failure to conduct intention-to-treat analysis, selective reporting, and apparent protocol deviations. We assessed three studies as at high risk of bias in at least one domain, and many studies had additional domains with unclear risk of bias. Four studies received funding from homeopathy manufacturers; one study support from a non-government organisation; two studies government support; one study was co-sponsored by a university; and three studies did not report funding support. Methodological inconsistencies and significant clinical and statistical heterogeneity precluded robust quantitative meta-analysis. Only four outcomes were common to more than one study and could be combined for analysis. Odds ratios (OR) were generally small with wide confidence intervals (CI), and the contributing studies found conflicting effects, so there was little certainty that the efficacy of the intervention could be ascertained. All studies assessed as at low risk of bias showed no benefit from oral homeopathic medicinal products, whilst trials at unclear or high risk of bias reported beneficial effects. For the comparison of individualised homeopathy versus placebo or usual care for the prevention of ARTIs, two trials reported on disease severity; due to heterogeneity the data were not combined, but neither study demonstrated a clinically significant difference. We combined data from two trials for the outcome need for antibiotics (OR 0.79, 95% CI 0.35 to 1.76; low-certainty evidence). For the comparison of non-individualised homeopathy versus placebo or usual care for the prevention of ARTIs, only the outcome recurrence of ARTI was reported by more than one trial; data from three studies were combined for this outcome (OR 0.60, 95% CI 0.21 to 1.72; low-certainty evidence). For the comparison of both individualised and non-individualised homeopathy versus placebo or usual care for the treatment of ARTIs, two studies provided data on short-term cure (OR 1.31, 95% CI 0.09 to 19.54) and long-term cure (OR 1.01, 95% CI 0.10 to 9.96; very low-certainty evidence). The studies demonstrated an opposite direction of effect for both outcomes. Six studies reported on disease severity but were not combined as they used different scoring systems and scales. Three studies reported adverse events (OR 0.79, 95% CI 0.16 to 4.03; low-certainty evidence). AUTHORS' CONCLUSIONS Pooling of five prevention and six treatment studies did not show any consistent benefit of homeopathic medicinal products compared to placebo on ARTI recurrence or cure rates in children. We assessed the certainty of the evidence as low to very low for the majority of outcomes. We found no evidence to support the efficacy of homeopathic medicinal products for ARTIs in children. Adverse events were poorly reported, and we could not draw conclusions regarding safety.
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Affiliation(s)
- Kate Hawke
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - David King
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Mieke L van Driel
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Treasure M McGuire
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Mater Pharmacy, Mater Health South East Queensland, Brisbane, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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21
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Gartlehner G, Emprechtinger R, Hackl M, Jutz FL, Gartlehner JE, Nonninger JN, Klerings I, Dobrescu AI. Assessing the magnitude of reporting bias in trials of homeopathy: a cross-sectional study and meta-analysis. BMJ Evid Based Med 2022; 27:345-351. [PMID: 35292534 PMCID: PMC9691824 DOI: 10.1136/bmjebm-2021-111846] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the magnitude of reporting bias in trials assessing homeopathic treatments and its impact on evidence syntheses. DESIGN A cross-sectional study and meta-analysis. Two persons independently searched Clinicaltrials.gov, the EU Clinical Trials Register and the International Clinical Trials Registry Platform up to April 2019 to identify registered homeopathy trials. To determine whether registered trials were published and to detect published but unregistered trials, two persons independently searched PubMed, Allied and Complementary Medicine Database, Embase and Google Scholar up to April 2021. For meta-analyses, we used random effects models to determine the impact of unregistered studies on meta-analytic results. MAIN OUTCOMES AND MEASURES We report the proportion of registered but unpublished trials and the proportion of published but unregistered trials. We also assessed whether primary outcomes were consistent between registration and publication. For meta-analyses, we used standardised mean differences (SMDs). RESULTS Since 2002, almost 38% of registered homeopathy trials have remained unpublished, and 50% of published randomised controlled trials (RCTs) have not been registered. Retrospective registration was more common than prospective registration. Furthermore, 25% of primary outcomes were altered or changed compared with the registry. Although we could detect a statistically significant trend toward an increase of registrations of homeopathy trials (p=0.001), almost 30% of RCTs published during the past 5 years had not been registered.A meta-analysis stratified by registration status of RCTs revealed substantially larger treatment effects of unregistered RCTs (SMD: -0.53, 95% CI -0.87 to -0.20) than registered RCTs (SMD: -0.14, 95% CI -0.35 to 0.07). CONCLUSIONS Registration of published trials was infrequent, many registered trials were not published and primary outcomes were often altered or changed. This likely affects the validity of the body of evidence of homeopathic literature and may overestimate the true treatment effect of homeopathic remedies.
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Affiliation(s)
- Gerald Gartlehner
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
- RTI International, Research Triangle Park, North Carolina, USA
| | - Robert Emprechtinger
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Marlene Hackl
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | | | | | | | - Irma Klerings
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Andreea Iulia Dobrescu
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
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22
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Millward J, McKay K, Holmes JT, Owens CT. Pharmacist Knowledge and Perceptions of Homeopathy: A Survey of Recent Pharmacy Graduates in Practice. PHARMACY 2022; 10:pharmacy10050130. [PMID: 36287451 PMCID: PMC9608643 DOI: 10.3390/pharmacy10050130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
Homeopathic products are available over the counter in many pharmacies in the United States and are popular among consumers, although there is no conclusive evidence of their therapeutic effects. Pharmacists are obligated to provide well-informed, evidence-based information on these products, but many graduates may not be receiving adequate training in this area. This report outlines the results of a survey assessing whether taking a focused elective course in complementary and integrative health (CIH) affects knowledge and perceptions regarding homeopathy. A 22-question survey was developed and distributed to graduates of Idaho State University College of Pharmacy. Responses on survey items were compared between those who had reported taking the CIH elective course and those who had not. Of the 475 pharmacists, 89 completed the survey (response rate of 18.7%). Pharmacists who had taken the CIH elective course reported being more comfortable answering patient questions (82% vs. 44%, p < 0.001), felt more able to make recommendations (75% vs. 36%, p < 0.001), and felt they could explain the proposed mechanism of action of homeopathic remedies to their patients (87% vs. 61%, p = 0.002). Those who took the elective course were also more likely to say that any benefits of homeopathy were due to the placebo effect (82% vs. 64%, p = 0.007). A significantly higher portion of respondents who had not taken the elective course indicated that they could benefit from further training on CIH topics when compared with those who had taken the elective course (85% vs. 51%, p = 0.02). There was no significant difference between groups with respect to their use of reliable resources (e.g., PubMed and Natural Medicines) vs. unreliable sources (other internet searches or personal anecdotes) when addressing CIH-related questions. These findings indicate that pharmacists with more focused training in CIH are more comfortable, confident, and knowledgeable when discussing homeopathy. Such education should be provided more broadly to students in colleges of pharmacy.
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Affiliation(s)
- Jordin Millward
- Department of Pharmacy Practice, Kasiska Division of Health Sciences, Idaho State University, Pocatello, ID 83209, USA
| | - Kasidy McKay
- Department of Pharmacy Practice, Kasiska Division of Health Sciences, Idaho State University, Pocatello, ID 83209, USA
- Department of Family Medicine, Idaho State University, Pocatello, ID 83209, USA
| | - John T. Holmes
- Department of Pharmacy Practice, Kasiska Division of Health Sciences, Idaho State University, Pocatello, ID 83209, USA
- Department of Family Medicine, Idaho State University, Pocatello, ID 83209, USA
| | - Christopher T. Owens
- Department of Pharmacy Practice, Kasiska Division of Health Sciences, Idaho State University, Pocatello, ID 83209, USA
- Correspondence: ; Tel.: +1-(208)-406-4161
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23
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Evidence-Based Human Homeopathy and Veterinary Homeopathy. Comment on Bergh et al. A Systematic Review of Complementary and Alternative Veterinary Medicine: “Miscellaneous Therapies”. Animals 2021, 11, 3356. Animals (Basel) 2022; 12:ani12162097. [PMID: 36009687 PMCID: PMC9404715 DOI: 10.3390/ani12162097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/13/2022] [Accepted: 06/09/2022] [Indexed: 12/18/2022] Open
Abstract
Simple Summary According to the simile principle (Similia similibus curentur, or ‘Let like be cured by like’), classical (=individualized) homeopathic therapy is based on the individual and not on the indication. Based on the following three facts, the discussion of the evidence in human and veterinary homeopathy lays the foundations for a comprehensive presentation of the evidence on homeopathy: (a) homeopathic medicinal products without indication are 100% identical with regard to production, quality, safety, and principles of application, regardless of whether they are used in animals or humans; (b) if the simile principle is adhered to that classical (=individualized) homeopathic therapy is based on the individual and not on the indication; and (c) if the proof of effectiveness of individualized homeopathy in one or more indications is available, the logical consequence seems to be that it can be concluded that it is effective in other indications. When criteria for evidence-based medicine for design, conduction, documentation, and rating of studies in homeopathy are considered, effects on all quality levels according to Cochrane criteria are recognizable, especially for individualized homeopathy, even in methodologically high-quality studies. In view of One Health and of the demands of the European Green Deal (Farm2Fork Strategy) and the EU Organic Regulation 2018/848, the application of homeopathy in the sense of integrative veterinary medicine (a combination of patient-oriented conventional and complementary veterinary medicine) and the integration of complementary medicine including homeopathy at the universities seems a necessary consequence and requirement in the interests of the patient. Abstract (1) Background: Classical (=individualized) homeopathic therapy is based on the individual and not on the indication. (2) Methods: The prerequisite for conducting methodologically high-quality studies on indvidualized homeopathy is that the principles of homeopathy are considered, since the selection of the simile (the individually appropriate homeopathic medicinal product) is decisive for the effectiveness of the homeopathic treatment, because only an application lege artis can be effective for the respective patient. Apart from this, criteria for evidence-based medicine must be considered for design, conduction, documentation, and rating of studies in homeopathy. (3) Results: When criteria for evidence-based medicine for design, conduction, documentation, and rating of studies in homeopathy are considered, effects on all quality levels according to Cochrane criteria are recognizable, especially for individualized homeopathy, even in the methodologically high-quality studies. (4) Conclusions: Based on the following three facts, the discussion of the evidence in human and veterinary homeopathy lays the foundations for a comprehensive presentation of the evidence on homeopathy: (a) homeopathic medicinal products without indication are 100% identical with regard to production, quality, safety, and principles of application, regardless of whether they are used in animals or humans; (b) if the simile principle (Similia similibus curentur, or ‘Let like be cured by like’) is adhered to that classical (=individualized) homeopathic therapy is based on the individual and not on the indication; and (c) if the proof of effectiveness of individualized homeopathy in one or more indications is available, the logical consequence seems to be that it can be concluded that it is effective in other indications. In view of One Health and of the demands of the European Green Deal (Farm2Fork Strategy) and the EU Organic Regulation 2018/848, the application of homeopathy in the sense of integrative veterinary medicine and the integration of complementary medicine including homeopathy at universities seems a necessary consequence and requirement in the interests of the patient, which is already expressed in the American consensus guidelines for an integrative veterinary medicine curriculum and is legally anchored in Switzerland by the Medical Professions Act for university teaching and research.
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Weiermayer P, Keusgen M, Pannek J, Panhofer P, Geiger M, Etter-Kalberer G, Tournier AL, Ulbrich Zürni S, Kruse S, Kretzdorn K, Frass M. [How is evidence-based medicine defined? Homeopathy-a therapeutic option in medical practice!]. HNO 2021; 70:72-74. [PMID: 34919156 DOI: 10.1007/s00106-021-01122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Petra Weiermayer
- Wissenschaftliche Gesellschaft für Homöopathie (WissHom), Wallstraße 48, 06366, Köthen, Deutschland.
| | - Michael Keusgen
- Pharmazeutische Chemie, Universität Marburg, Marburg, Deutschland
| | - Jürgen Pannek
- Neuro-Urologie, Schweizer Paraplegiker-Zentrum, Guido A. Zäch Str. 1, 6207, Nottwil, Schweiz
| | - Peter Panhofer
- Komplementärmedizin, Medizinische Fakultät, Sigmund Freud Universität Wien, Wien, Österreich
| | - Michaela Geiger
- Deutscher Zentralverein Homöopathischer Ärzte (DZVhÄ), Berlin, Deutschland.,Hufelandgesellschaft, Berlin, Deutschland
| | | | - Alexander Louis Tournier
- Institut für Komplementäre und Integrative Medizin, Universität Bern, Bern, Schweiz.,Homeopathy Research Institute, London, Großbritannien
| | - Susanne Ulbrich Zürni
- Wissenschaftliche Gesellschaft für Homöopathie (WissHom), Wallstraße 48, 06366, Köthen, Deutschland.,Österreichischer Dachverband für ärztliche Ganzheitsmedizin, Wien, Österreich
| | - Sigrid Kruse
- Wissenschaftliche Gesellschaft für Homöopathie (WissHom), Wallstraße 48, 06366, Köthen, Deutschland
| | - Karoline Kretzdorn
- Wissenschaftliche Gesellschaft für Homöopathie (WissHom), Wallstraße 48, 06366, Köthen, Deutschland
| | - Michael Frass
- Wissenschaftliche Gesellschaft für Homöopathie (WissHom), Wallstraße 48, 06366, Köthen, Deutschland.,Österreichischer Dachverband für ärztliche Ganzheitsmedizin, Wien, Österreich
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Luu NN, Soldatova L, Friedman O. The Role of Complementary and Alternative Medicine in Facial Plastic Surgery. Facial Plast Surg 2021; 38:88-93. [PMID: 34749403 DOI: 10.1055/s-0041-1736582] [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] Open
Abstract
Complementary and alternative medicine (CAM) has become increasingly popular among facial plastic surgery patients. Over the last few decades, there has been a surge in the use of CAM. Despite the increasing prevalence of CAM, patients may feel uncomfortable discussing these therapies with their physicians, and physicians feel under-equipped to engage in meaningful discussions regarding these nontraditional therapies. This article reviews recent literature on the use of CAM for skin treatment in an attempt to provide additional resource. To date, the evidence to support statistically significant symptom improvement with use of non-traditional therapies remains limited. While preliminary data supports essential oil therapy in some cases, the results of the studies investigating other CAM therapies (traditional Chinese medicine, Ayurveda, and homeopathy) have been mixed and inconclusive.
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Affiliation(s)
- Neil N Luu
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck Medicine at the University of Southern California, Los Angeles, California
| | - Liuba Soldatova
- Hospital of the University of Pennsylvania, Department of Otorhinolaryngology - Head and Neck Surgery, Philadelphia, Pennsylvania
| | - Oren Friedman
- Hospital of the University of Pennsylvania, Department of Otorhinolaryngology - Head and Neck Surgery, Philadelphia, Pennsylvania
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27
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[Complementary medicine in uro-oncology]. Urologe A 2021; 60:953-962. [PMID: 34129061 DOI: 10.1007/s00120-021-01584-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Abstract
Complementary and alternative medicine (CAM) is widespread in oncology patients with a user rate of approximately 40-50%. An accompanying supportive effect can arise through improved adherence, especially in long-term (e.g. endocrine) therapies through active patient involvement. When assessing the evidence on frequently requested methods, there is no high-quality evidence that homeopathy or anthroposophy leads to an improved prognosis. Mistletoe therapy can be considered to improve the quality of life, although the data quality is weak. In prostate cancer, pomegranate has an influence on the prostate-specific antigen. It is currently unclear whether this will also result in an improved prognosis. In contrast the evidence on selenium and vitamin D speaks in favor of integration into the aftercare concept. Supplementation is recommended after the serum level has been determined.
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Rydzewska E, Dunn K, Cooper SA, Kinnear D. Mental ill-health in mothers of people with intellectual disabilities compared with mothers of typically developing people: a systematic review and meta-analysis. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:501-534. [PMID: 33738865 DOI: 10.1111/jir.12827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/01/2020] [Accepted: 02/20/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Mothers of people with intellectual disabilities (IDs) face exceptional challenges and may be more prone to experiencing mental ill-health compared with mothers of typically developing people. These mental ill-health problems may differ at different stages of the caregiving trajectory. However, there is no evidence synthesis on this topic. We aimed to systematically review evidence in this area and identify gaps in the existing literature. METHOD Prospero registration: CRD42018088197. Medline, Embase, CINAHL and PsycINFO databases were searched. No time limits were applied. Studies were limited to English language. Inclusion criteria were studies of mothers of people with IDs that also included a comparison group of mothers of typically developing/developed children. Data were extracted from selected studies using a structured database. Study selection and quality appraisal were double rated. Where possible, meta-analyses were performed. RESULTS Of the retrieved articles, 32/3089 were included, of which 10 reported on anxiety, 21 on depression and 23 on other indicators of mental ill-health. Overall, previous studies reported that mothers of people with IDs experienced poorer mental health as compared with mothers of typically developing people. Meta-analyses revealed significant findings for anxiety, depression, parenting stress, emotional burden and common mental disorders, but not for somatic symptoms. However, there was a considerable heterogeneity; hence, interpretation of results should be cautious. Identified gaps included scarce research on mental ill-health of mothers of adults with IDs at different stages of the caregiving trajectory. CONCLUSIONS There is evidence of poorer mental ill-health in mothers of people with IDs compared with mothers of typically developing people, but lack of focus on different stages of the caregiving trajectory, methodological inconsistencies between studies and lack of robust studies pose limitations. This highlights the need both for improved support for mothers of people with IDs and for further methodologically robust research.
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Affiliation(s)
- E Rydzewska
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - K Dunn
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - S-A Cooper
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - D Kinnear
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Lübbers CW, Endruscheit U. [Homeopathy-a therapeutic option for medical practice? : An evaluation from the perspective of evidence-based medicine]. HNO 2021; 69:679-690. [PMID: 34009440 PMCID: PMC8316206 DOI: 10.1007/s00106-021-01061-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/28/2022]
Abstract
Viele Veröffentlichungen bezeichnen die Homöopathie als „umstritten“. Angesichts umfangreicher Forschungsergebnisse zur Homöopathie besteht jedoch längst weitestgehend wissenschaftlicher Konsens dahin, dass es keinen belastbaren Beleg für eine spezifische medizinische Wirksamkeit gibt. Die Gesamtevidenz spricht klar gegen Effekte, die über die von Placebo- und anderen Kontexteffekten hinausgehen. Umso mehr muss es als Phänomen erscheinen, dass die Homöopathie nach wie vor Gegenstand medizinisch-therapeutischer Praxis ist. Dies mag eine wesentliche Ursache darin haben, dass sich die homöopathische Szene der medizinischen Forschung und des Evidenzbegriffs auf eine Weise bemächtigt, die geeignet ist, den Anschein aufrechtzuerhalten, es gäbe noch einen wissenschaftlich relevanten Diskurs zu bestreiten. Dass dies nicht der Fall ist und deshalb die Homöopathie als therapeutische Option, auch nach den Grundsätzen zeitgemäßer Medizinethik, obsolet ist, will der nachstehende Beitrag begründen.
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Schmidt JM. The Need for Multidisciplinary Research within the History and Theory of Homeopathy. HOMEOPATHY 2021; 110:137-146. [PMID: 32898897 PMCID: PMC11111288 DOI: 10.1055/s-0040-1714740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/12/2020] [Indexed: 10/23/2022]
Abstract
The controversial issue of homeopathy's scientificity will, in all probability, not be settled by means of clinical trials alone, as long as uncertainty or ignorance about methodological, philosophical, and socio-economical essentials prevail on both sides of the argument. Rather than uncritically adopt the standards of the currently predominant paradigm, homeopathy should not forget its roots, peculiarities, and self-conception. Contrary to conventional medicine, it is based on a teleological image of humanity, a holistic and sustainable approach towards curing sickness, and an up-to-date concept of medical theory in terms of healing arts. However, under today's frameworked conditions of industrialisation, commercialisation and commodification, the strengths of homeopathy tend to be disregarded or even attacked, and a special kind of reductionist and materialist rationality, compatible with expanding markets and profits, is preferably facilitated. To reveal and demonstrate these developments and relationships on a scientific level, there is a need for multidisciplinary research on the part of the humanities, such as history and theory of medicine, history and theory of science, history of economics, sociology of scientific knowledge, and philosophy.
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Affiliation(s)
- Josef M. Schmidt
- Institute of Ethics, History, and Theory of Medicine, Ludwig Maximilian's University, Munich, Germany
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31
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King D, Hawke K, McGuire TM, van Driel M. Homeopathic Preparations for Preventing and Treating Acute Upper Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis. Acad Pediatr 2021; 21:211-220. [PMID: 32698039 DOI: 10.1016/j.acap.2020.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 06/05/2020] [Accepted: 07/17/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Acute upper respiratory tract infections (ARTIs) are common and mostly self-limiting. A range of treatments are used with the aim to cure or treat symptoms, including widespread use of homeopathic treatments. OBJECTIVE To undertake a systematic review and meta-analysis of trials with the highest level of evidence, to establish the benefits and risks for oral homeopathic remedies used to treat and prevent ARTIs in children. DATA SOURCES MEDLINE, Embase, CINAHL, AMED, CAMbase, British Homeopathic Library, CENTRAL, WHO ICTRP and ClinicalTrials.gov registers to March 2018. STUDY ELIGIBILITY, PARTICIPANTS, AND INTERVENTIONS Double-blinded randomized trials in children, treated with oral homeopathic remedies versus placebo or conventional treatments for ARTI. APPRAISAL AND SYNTHESIS METHODS Studies were reviewed in duplicate for inclusion, data extraction, and risk of bias. Meta-analysis was performed on only 4 outcomes. Other outcomes were reported narratively. RESULTS Eight studies (1562 children) were included. Four studies examined treatment and 4 prevention of ARTIs. Four studies involved homeopaths individualizing treatment versus four with non-individualized treatments. Three studies had high risk of bias in at least 1 domain. All studies with low risk of bias showed no benefit from homeopathy; trials at uncertain and high risk of bias reported beneficial effects. Two individualized treatment studies (N = 155) did not show benefit on short-term or long-term cure. Prevention trials showed no significant outcomes: recurrence of ARTIs. No serious events were reported. LIMITATIONS Methodological inconsistencies and heterogeneity. CONCLUSIONS The effectiveness for homeopathic remedies for childhood ARTIs is not supported in higher quality trials.
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Affiliation(s)
- David King
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital (D King and M van Driel), Brisbane, Queensland, Australia.
| | - Kate Hawke
- Princess Alexandra-Southside Clinical Unit, School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Translational Research Institute, Princess Alexandra Hospital (K Hawke), Woolloongabba, Queensland, Australia
| | - Treasure M McGuire
- School of Pharmacy, The University of Queensland (TM McGuire), Woolloongabba, Queensland, Australia; Mater Pharmacy, Mater Health (TM McGuire), South Brisbane, Queensland, Australia; Faculty of Health Sciences and Medicine, Bond University (TM McGuire), Robina, Queensland, Australia
| | - Mieke van Driel
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital (D King and M van Driel), Brisbane, Queensland, Australia
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32
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Homeopathic Remedies in Psychiatric Disorders: A Meta-analysis of Randomized Controlled Trials. J Clin Psychopharmacol 2021; 40:269-275. [PMID: 32332462 DOI: 10.1097/jcp.0000000000001196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE/BACKGROUND Homeopathy is a complementary and alternative medicine. Conclusive evidence on the plausibility, efficacy, and safety of these treatments is not currently available. Nonetheless, homeopathic remedies (HRs) are widespread throughout the world and especially in mental disorders. The aim is to assess the efficacy of HRs in the treatment of mental disorders. METHODS/PROCEDURES We performed a Medline/Embase search for studies written in English and published from any date to October 23, 2018. All randomized controlled trials enrolling patients with any psychiatric disorder and comparing HR with placebo, no treatment, or other psychotropic drugs were included. FINDINGS/RESULTS A total of 212 studies were screened, 9 met all selection criteria and reported data on major depressive disorder (MDD) (n = 4), generalized anxiety disorder (n = 1), attention-deficit/hyperactivity disorder (n = 2), and premenstrual syndrome/dysphoric disorder (n = 2). Eight of 9 randomized controlled trials showed high risk of bias. Homeopathy showed greater efficacy in MDD compared with fluoxetine, and in premenstrual syndrome/dysphoric disorder compared with placebo, whereas no difference emerged between homeopathy and placebo in MDD and attention deficit/hyperactivity disorder. IMPLICATIONS/CONCLUSIONS Available data on homeopathy in psychiatric disorders are insufficient to support their use in clinical practice.
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Bartelme RR. Anthroposophic Medicine: A Short Monograph and Narrative Review-Foundations, Essential Characteristics, Scientific Basis, Safety, Effectiveness and Misconceptions. Glob Adv Health Med 2020; 9:2164956120973634. [PMID: 33457106 PMCID: PMC7783888 DOI: 10.1177/2164956120973634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/29/2020] [Accepted: 10/08/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Anthroposophic medicine is a form of integrative medicine that originated in Europe but is not well known in the US. It is comprehensive and heterogenous in scope and remains provocative and controversial in many academic circles. Assessment of the nature and potential contribution of anthroposophic medicine to whole person care and global health seems appropriate. METHODS Because of the heterogenous and multifaceted character of anthroposophic medicine, a narrative review format was chosen. A Health Technology Assessment of anthroposophic medicine in 2006 was reviewed and used as a starting point. A Medline search from 2006 to July 2020 was performed using various search terms and restricted to English. Books, articles, reviews and websites were assessed for clinical relevance and interest to the general reader. Abstracts of German language articles were reviewed when available. Reference lists of articles and the author's personal references were also consulted. RESULTS The literature on anthroposophic medicine is vast, providing new ways of thinking, a holistic view of the world, and many integrating concepts useful in medicine. In the last ∼20 years there has been a growing research base and implementation of many anthroposophical concepts in the integrated care of patients. Books and articles relevant to describing the foundations, scientific status, safety, effectiveness and criticisms of anthroposophic medicine are discussed. DISCUSSION An objective and comprehensive analysis of anthroposophic medicine finds it provocative, stimulating and potentially fruitful as an integrative system for whole person care, including under-recognized life processes and psychospiritual aspects of human beings. It has a legitimate, new type of scientific status as well as documented safety and effectiveness in some areas of its multimodal approach. Criticisms and controversies of anthroposophic medicine are often a result of lack of familiarity with its methods and approach and/or come from historically fixed ideas of what constitutes legitimate science.
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Affiliation(s)
- Ricardo R Bartelme
- Department of Family Medicine, University of Michigan Medical
School, Ann Arbor, Michigan
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Amaral TG, Zina LG, Paula JSD. Systematic Review on the Use of Homeopathy in Dentistry: Critical Analysis of Clinical Trials. J Altern Complement Med 2020; 27:214-224. [PMID: 33170020 DOI: 10.1089/acm.2020.0271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: The objective of this research was to systematically map the literature on homeopathy and dentistry studies and to evaluate the effectiveness of using homeopathy in dental practice through the critical analysis of clinical studies. Design: The search for scientific articles in any language, year, and place of publication was made in the databases of Public Medline (PUBMED), Web of Science, Cochrane, and Virtual Health Library; the articles selected were later classified according to the type of study. Gray literature was accessed through Google Scholar. Clinical trials were analyzed for methodological quality. Two previously trained reviewers accomplished the entire process independently. Results: Of the 281 studies retrieved by means of the search, 44 met the eligibility criteria, with prevalence of literature reviews (56.8%), followed by clinical trials (34.1%), cross-sectional studies (6.8%), laboratory research (6.8%), and longitudinal observational studies (4.5%). The clinical trials identified were published from 1965 to 2019, using homeopathy in several dental specialties: in Endodontics, Periodontics, Orofacial Pain, Surgery, Pediatric Dentistry, and Stomatology, as well as in cases of dental anxiety. Qualitative failures, in all criteria investigated, and positive influences of the individual prescriptions on the results of treatments reported were observed. Conclusions: There is still a scarcity of studies about homeopathy and dentistry. The clinical trials selected showed positive effects on oral health; however, when they were critically evaluated, it was possible to recognize qualitative failures, mainly relative to double-blinding. It is necessary to encourage research on the subject, using standardized methodological procedures, to obtain better evaluation of the clinical applicability.
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Affiliation(s)
- Taísa Gomes Amaral
- Department of Community and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lívia Guimarães Zina
- Department of Community and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Janice Simpson de Paula
- Department of Community and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Suter G, Nichols J, Lavoie E, Cormier S. Systematic Review and Weight of Evidence Are Integral to Ecological and Human Health Assessments: They Need an Integrated Framework. INTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT 2020; 16:718-728. [PMID: 32196925 PMCID: PMC7551547 DOI: 10.1002/ieam.4271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/14/2020] [Accepted: 03/17/2020] [Indexed: 05/21/2023]
Abstract
Scientific assessments synthesize the various results of scientific research for policy and decision making. Synthesizing evidence in environmental assessments can involve either or both of 2 systems: systematic review (SR) and weight of evidence (WoE). Systematic review was developed to systematically assemble results of clinical trials to be combined by meta-analysis. Weight-of-evidence approaches have evolved from jurisprudence to make inferences from diverse bodies of evidence in various fields. Our objectives are to describe the similarities and differences between SR and WoE and to suggest how their best practices can be combined into a general framework that is applicable to human health and ecological assessments. Integrating SR and WoE is based on the recognition that 2 processes are required, assembling evidence and making an inference. Systematic review is characterized by methodical literature searching, screening, and data extraction, originally for meta-analysis but now for various inferential methods. Weight of evidence is characterized by systematically relating heterogeneous evidence to considerations appropriate to the inference and making the inference by weighing the evidence. Systematic review enables the unbiased assembly of evidence from literature, but methods for assembling other information must be considered as well. If only 1 type of quantitative study estimates the assessment endpoint, meta-analysis is appropriate for inference. Otherwise, the heterogeneous evidence must be weighed. A framework is presented that integrates best practices into a methodical assembly and weighing of evidence. A glossary of terms for the combined practice and a history of the origins of SR and WoE are provided in Supplemental Data. Integr Environ Assess Manag 2020;16:718-728. Published 2020. This article is a US Government work and is in the public domain in the USA.
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Affiliation(s)
- Glenn Suter
- Office of Research and Development, Emeritus, United States Environmental Protection Agency, Cincinnati, Ohio
| | - Jennifer Nichols
- Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, North Carolina
| | - Emma Lavoie
- Office of Research and Development, US Environmental Protection Agency, Washington, DC
| | - Susan Cormier
- Office of Research and Development, US Environmental Protection Agency, Cincinnati, Ohio
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Goetz K, Kalder M, Albert US, Jacke CO. The usage of over-the-counter products by private insured patients in Germany - a claims data analysis with focus on complementary medicine. BMC Health Serv Res 2020; 20:651. [PMID: 32660646 PMCID: PMC7359243 DOI: 10.1186/s12913-020-05501-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 07/02/2020] [Indexed: 12/12/2022] Open
Abstract
Background An important contribution to well-being of human beings can be observed by the use of self-medication products that is reflected in the constantly growing volume of over-the-counter (OTC) drugs. The aim of the current study was to extend the measurement concept for OTCs by exploring the relevance of the peripheral assortment provided by the widely accepted framework of the Anatomical Therapeutical and Chemical (ATC) classification of the WHO. Methods The focus was on the prescriptions and drug-related receipts submitted by privately insured persons to 18 private health insurers (PHIs) in Germany from the year 2016. The age- and gender-specific average claims amount per risks of outpatient drug expenditure were used as weights to scale up the relative distributions of the item amounts. The ATC-classification defines the commodity groups and discriminates between the main and the peripheral assortment. A descriptive analysis assessed the OTC frequencies and sum scores of the product groups within the main and peripheral assortment whereby the study group explored and assessed the relevance of each category independently according to the OTCs and integrative medicines. Results The analysis included 22.1 Mio. packages from the main assortment and examined 10.1 Mio. packages from the peripheral assortment. The latter was examined thoroughly and the commodity groups “Pharmaceutical food products”, “Medicinal products for special therapy options” and particular “Hygiene and body care products” meet the defined requirements for OTCs relevant for integrative medicines. A high proportion of OTC products from the peripheral assortment was associated with the categories “medicinal products for special therapy options”. Homeopathy and anthroposophy present two special therapy options, which are relevant for the extended OTC measurement. Conclusions The analysis of OTC drugs is feasible when the main and the peripheral assortment is available and enable to integrate about 18% of all OTCs, which are neglected by the common ATC-based approach. The presented extended approach may help to identify potential users of OTCs or people in need of OTC use. In case of the highly disputed homeopathy and anthroposophy products, more research among interactions with prescriptions drugs (Rx), nutrition’s and other potentially harmful exposures is recommended.
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Affiliation(s)
- Katja Goetz
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 16, Building 50, 23538, Lübeck, Germany.
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, Philipps University of Marburg, Baldingerstr., 35043, Marburg, Germany
| | - Ute-Susann Albert
- Department for Obstetrics and Gynecology, University Hospital Würzburg, Josef-Schneider-Straße 4, 97080, Würzburg, Germany
| | - Christian O Jacke
- Scientific Institute of Private Health Insurance (WIP), Gustav-Heinemann-Ufer 74c, 50968, Köln, Germany
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Moulin TC, Amaral OB. Using collaboration networks to identify authorship dependence in meta-analysis results. Res Synth Methods 2020; 11:655-668. [PMID: 32583923 DOI: 10.1002/jrsm.1430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 06/02/2020] [Accepted: 06/12/2020] [Indexed: 01/20/2023]
Abstract
Meta-analytic methods are powerful resources to summarize the existing evidence concerning a given research question and are widely used in many academic fields. Meta-analyzes can also be used to study sources of heterogeneity and bias among results, which should be considered to avoid inaccuracies. Many of these sources can be related to study authorship, as both methodological heterogeneity and researcher bias may lead to deviations in results between different research groups. In this work, we describe a method to objectively attribute study authorship within a given meta-analysis to different research groups by using graph cluster analysis of collaboration networks. We then provide empirical examples of how the research group of origin can impact effect size in distinct types of meta-analyzes, demonstrating how non-independence between within-group results can bias effect size estimates if uncorrected. Finally, we show that multilevel random-effects models using research group as a level of analysis can be a simple tool for correcting for authorship dependence in results.
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Affiliation(s)
- Thiago C Moulin
- Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Olavo B Amaral
- Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Habs M, Koller M. Material Risks of Homeopathic Medicinal Products: Regulatory Frameworks, Results of Preclinical Toxicology, and Clinical Meta-Analyses and Their Implications. Complement Med Res 2020; 28:64-84. [PMID: 32610325 DOI: 10.1159/000507952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/31/2020] [Indexed: 11/19/2022]
Abstract
Homeopathy is widely used and broadly accepted by health care professionals and the general public but less in academic circles. To assess possible material health risks of homeopathic medicinal products, it is necessary to identify, select, and synthesize the findings of recent reviews of controlled homeopathic clinical trials. Matching these findings with experimental data from toxicological studies helps to clarify what is known and not known about the material risks of homeopathic medicines. Rules for toxicological risk assessment and management need to be applied independently of individual attitudes towards specific therapeutic options. European regulatory bodies have developed special protocols and decision trees to assure the safety of nonindividualized homeopathic remedies. This narrative review leads to suggestions that could ease and improve toxicological decision making. No homeopathy-specific type or pattern of side effects could be extracted from the meta-analysis data. No differences in the frequency of adverse reactions between homeopathic treatment and placebo treatment could be seen, no matter whether adverse events were reported in a quantitative or a qualitative manner. Some patterns of side effects show that adverse reactions do not necessarily correlate with treatment but with the condition of the patient. Overall, the controlled clinical data available for the material risk assessment of homeopathic remedies support the statement that, if a risk exists, it must be so small that it has not yet been established. To make our risk findings useful for personal decisions regarding homeopathy, we provide a thought experiment based on four different health situations and ask the question: is homeopathy as a monotherapy or as an add-on treatment an option or should it be rejected?
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Affiliation(s)
- Michael Habs
- Faculty of Medicine, LMU - University of Munich, Munich, Germany
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany,
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Taype-Rondan A, Miñan-Tapia A, Alarcon-Ruiz CA, Zafra-Tanaka JH. Factores asociados a la percepción de la validez científica de la homeopatía en un grupo de médicos generales de Perú. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.15446/revfacmed.v68n2.72116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La homeopatía es una terapia ampliamente utilizada en diversas partes del mundo; sin embargo, su eficacia no se ha comprobado científicamente.Objetivo. Evaluar los factores asociados a la percepción de la validez científica de la homeopatía en médicos generales de Perú.Materiales y métodos. Estudio transversal analítico. Se realizaron encuestas autoaplicadas a médicos generales que asistieron a los cursos de capacitación y orientación vocacional en especialidad y residentado en salud del Colegio Médico del Perú en 2017. La variable principal del estudio se evaluó por medio de la siguiente pregunta: ¿considera que la eficacia de la homeopatía está científicamente probada? Para evaluar los factores asociados se calcularon razones de prevalencia crudas (RP) y ajustadas (RPa), así como sus intervalos de confianza al 95% (IC95%).Resultados. Se incluyeron 285 médicos generales (55.1% mujeres) con una edad mediana de 28 años. Del 67.4% que reportó haber escuchado sobre la homeopatía, 22.5% consideró que su eficacia estaba científicamente comprobada. Lo anterior fue más frecuente en mujeres (RPa: 1.80; IC95%: 1.03-3.16) y menos frecuente en quienes habían publicado algún artículo científico (RPa: 0.23; IC95%:0.06-0.88).Conclusiones. Una parte de los médicos encuestados considera que la eficacia de la homeopatía está científicamente comprobada. Lo anterior puede deberse a vacíos en la educación médica con respecto a las terapias médicas alternativas y complementarias, así como a la influencia de la educación no formal en la toma de decisiones del médico joven.
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Eizayaga JE. Homeopathic nosodes are not vaccines. Vaccine 2020; 38:3517. [DOI: 10.1016/j.vaccine.2019.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 10/24/2022]
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Kossmeier M, Tran US, Voracek M. Power-Enhanced Funnel Plots for Meta-Analysis. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1027/2151-2604/a000392] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract. Currently, dedicated graphical displays to depict study-level statistical power in the context of meta-analysis are unavailable. Here, we introduce the sunset (power-enhanced) funnel plot to visualize this relevant information for assessing the credibility, or evidential value, of a set of studies. The sunset funnel plot highlights the statistical power of primary studies to detect an underlying true effect of interest in the well-known funnel display with color-coded power regions and a second power axis. This graphical display allows meta-analysts to incorporate power considerations into classic funnel plot assessments of small-study effects. Nominally significant, but low-powered, studies might be seen as less credible and as more likely being affected by selective reporting. We exemplify the application of the sunset funnel plot with two published meta-analyses from medicine and psychology. Software to create this variation of the funnel plot is provided via a tailored R function. In conclusion, the sunset (power-enhanced) funnel plot is a novel and useful graphical display to critically examine and to present study-level power in the context of meta-analysis.
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Affiliation(s)
- Michael Kossmeier
- Department of Basic Psychological Research and Research Methods, School of Psychology, University of Vienna, Austria
| | - Ulrich S. Tran
- Department of Basic Psychological Research and Research Methods, School of Psychology, University of Vienna, Austria
| | - Martin Voracek
- Department of Basic Psychological Research and Research Methods, School of Psychology, University of Vienna, Austria
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Raj PAA, Pavulraj S, Kumar MA, Sangeetha S, Shanmugapriya R, Sabithabanu S. Therapeutic evaluation of homeopathic treatment for canine oral papillomatosis. Vet World 2020; 13:206-213. [PMID: 32158174 PMCID: PMC7020120 DOI: 10.14202/vetworld.2020.206-213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022] Open
Abstract
Aim: A study was conducted to evaluate the ameliorative potential of homeopathic drugs in combination (Sulfur 30C, Thuja 30C, Graphites 30C, and Psorinum 30C) in 16 dogs affected with oral papillomatosis which was not undergone any previous treatment. Materials and Methods: Dogs affected with oral papillomatosis, which have not undergone any initial treatment and fed with a regular diet. Dogs (total=16) were randomly divided into two groups, namely, homeopathic treatment group (n=8) and placebo control group (n=8). Random number table was used for allocation. Homeopathic combination of drugs and placebo drug (distilled water) was administered orally twice daily for 15 days. Clinical evaluation in both groups of dogs was performed by the same investigator throughout the period of study (12 months). Dogs were clinically scored for oral lesions on days 0, 5, 7, 10, 15, 20, 25, 30, 45, 60, 90, 120, and 150 after initiation of treatment. Results: The homeopathic treatment group showed early recovery with a significant reduction in oral lesions reflected by clinical score (p<0.001) in comparison to placebo-treated group. Oral papillomatous lesions regressed in the homeopathic group between 7 and 15 days, whereas regression of papilloma in the placebo group occurred between 90 and 150 days. The homeopathic treated group was observed for 12 months post-treatment period and no recurrence of oral papilloma was observed. Conclusion: The current study proves that the combination of homeopathy drugs aids in fastening the regression of canine oral papilloma and proved to be safe and cost-effective.
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Affiliation(s)
- P Albert Arockia Raj
- Veterinary Dispensary, Department of Animal Husbandry, Radhapuram, Villupuram, Tamil Nadu, India
| | - Selvaraj Pavulraj
- Institute of Virology, Center for Infectious Medicine, Freie University of Berlin, Robert-von-Ostertag-Street 7-13, Berlin - 14163, Germany
| | - M Asok Kumar
- Division of Pathology, Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, India
| | - S Sangeetha
- Madras Veterinary College, Chennai, Tamil Nadu, India
| | | | - S Sabithabanu
- Madras Veterinary College, Chennai, Tamil Nadu, India
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Poitevin B. How can one evaluate the clinical effectiveness of homeopathic therapy? Some thoughts about the report of the High Authority for Health. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.revhom.2019.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Nelson DH, Perchaluk JM, Logan AC, Katzman MA. The Bell Tolls for Homeopathy: Time for Change in the Training and Practice of North American Naturopathic Physicians. J Evid Based Integr Med 2019; 24:2515690X18823696. [PMID: 30789055 PMCID: PMC6343431 DOI: 10.1177/2515690x18823696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
North American naturopathic medicine is a distinct form of practice that is woven into the larger fabric of integrative medicine; in a number of US states and Canadian provinces, naturopathic doctors enjoy a wide scope of practice, including the ability to make diagnoses, order tests, use medical technology, write prescription drugs, and perform minor surgeries. However, the basic premise of naturopathic medicine and its guiding principles-considering the whole person and supporting healthy lifestyle behaviors-is the unifying approach in clinical practice. In the 1970s, homeopathy-considered in many circles to be a hypothesis-driven, fringe form of alternative medicine-became embedded into the training and practice of North American naturopathic doctors. Since the earliest days of its theory (circa 1800), homeopathy has escaped, and continues to escape, biological plausibility; however, the persistence of this modality (and the insistence by both its consumers and practitioners that it provides benefit) speaks to the role of expectations, beliefs, values, agency, context effects, and the placebo-at-large. It is our contention that the progression of professional naturopathic medicine in the 21st century requires a major transition in how it approaches the subject of homeopathy. We propose that students should be encouraged to critically analyze the tenets of homeopathy, its lesser known history, and the idea of homeopathy as a biomedicine that simply awaits untold chemicophysical mechanisms. Furthermore, the modality of homeopathy should be incorporated into the larger context of placebo studies, narrative medicine, ethics, and psychotherapeutic techniques.
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Affiliation(s)
- David H Nelson
- 1 Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | | | - Alan C Logan
- 3 inVIVO Planetary Health, Research Group of the Worldwide Universities Network (WUN), West New York, NJ, USA
| | - Martin A Katzman
- 4 The Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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Doesburg P, Andersen JO, Scherr C, Baumgartner S. Empirical investigation of preparations produced according to the European Pharmacopoeia monograph 1038. Eur J Pharm Sci 2019; 137:104987. [DOI: 10.1016/j.ejps.2019.104987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/05/2019] [Accepted: 07/06/2019] [Indexed: 11/29/2022]
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Integrative oder alternative Kinder- und Jugendmedizin? Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-0737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Raak C, Krueger P, Klement P, De Jaegere S, Weber S, Keller T, Ilyenko L, Martin D, Ostermann T. Effectiveness of a homeopathic complex medicine in infantile colic: A randomized multicenter study. Complement Ther Med 2019; 45:136-141. [PMID: 31331550 DOI: 10.1016/j.ctim.2019.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/24/2019] [Accepted: 05/29/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Infantile colic is a common benign disease occurring in early infancy that may have a great impact on family life. In the present study, the effectiveness and safety of the complex homeopathic medicine Enterokind was compared with Simethicone for treating infantile colic. DESIGN AND SETTING Current data were drawn from a prospective, multicenter, randomized, open-label, controlled clinical trial that was conducted in 2009 in 3 Russian outpatient clinics. Children received either Enterokind (Chamomilla D6, Cina D6, Colocynthis D6, Lac defloratum D6 and Magnesium chloratum D6) or Simethicone. Data from infants ≤ 6 months with infantile colic are presented here. MAIN OUTCOME MEASURES The main outcomes assessments were the change of total complaints score (maximum 17 points) and total objective symptoms score (maximum 22 points) after 10 days of treatment. RESULTS Data from 125 infants ≤ 6 months with infantile colic were analyzed. The differences in total complaints and objective symptoms scores between baseline and day 10, estimated from the ANCOVA model, were found to be highly significant (p < 0.0001; ITT) in favor of Enterokind, both for complaints (Δ=-2.38; 95% confidence interval (CI): [-2.87; -1.89]) and for objective symptoms (Δ=-2.07; 95% CI: [-2.65; -1.49]). 1 adverse event (AE), vomiting, occurred under Enterokind and was rated to be unlikely related to it; 4 AEs occurred under Simethicone. All AEs were non-serious. CONCLUSIONS The current study indicates that Enterokind is an effective and safe homeopathic treatment for functional intestinal colic in infants ≤ 6 months.
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Affiliation(s)
- Christa Raak
- Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany.
| | - Peter Krueger
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Petra Klement
- Deutsche Homöopathie-Union, DHU-Arzneimittel GmbH & Co. KG, Karlsruhe, Germany
| | - Sabine De Jaegere
- Deutsche Homöopathie-Union, DHU-Arzneimittel GmbH & Co. KG, Karlsruhe, Germany
| | | | | | - Lydia Ilyenko
- Russian State Medical University, Moscow, Russian Federation
| | - David Martin
- Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | - Thomas Ostermann
- Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Witten, Germany
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Antonelli M, Donelli D. Reinterpreting homoeopathy in the light of placebo effects to manage patients who seek homoeopathic care: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:824-847. [PMID: 30456773 DOI: 10.1111/hsc.12681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 06/09/2023]
Abstract
Homoeopathy is widespread, and users claim to benefit from it. However, clear evidence of its efficacy over placebo is not available to date. As a consequence, a social separation between homoeopathy users and mainstream medicine exists, exposing these patients to many risks. Our primary objective is to assess homoeopathy efficacy by systematically reviewing existing systematic reviews and meta-analyses and to systematically review trials on open-label placebo (OLP) treatments. A secondary objective is to understand if homoeopathy as a whole may be considered as a placebo treatment. PubMed/Medline, Embase, Google Scholar, and Cochrane Library were systematically searched for systematic reviews and meta-analyses on homoeopathy efficacy, and 61 studies were included. Same databases plus Journal of Interdisciplinary Placebo Studies (JIPS) were also systematically searched for randomised controlled trials (RCTs) on OLP treatments, and 10 studies were included. Databases were searched up to 24 February 2018. Two authors independently screened all retrieved articles and selected studies eligible for inclusion. The quality of reviews of included studies was evaluated with a dedicated NIH tool in the first review, whereas the risk of bias of trials of included studies was assessed with the specific Cochrane tool in the second review. Qualitative syntheses show that homoeopathy efficacy can be considered comparable to placebo, and that OLP treatments may be effective in some health conditions. Placebo effects like placebo itself, treatment context, physician-patient relationship, and other nonspecific factors can define the idea of placebo treatments, which may be effective in some conditions. If homoeopathy efficacy is comparable to placebo, and if placebo treatments can be effective in some conditions, then homoeopathy as a whole may be considered as a placebo treatment. Reinterpreting homoeopathy as a placebo treatment would define limits and possibilities of this practice. This perspective shift suggests a strategy to manage patients who seek homoeopathic care and to reconcile them with mainstream medicine in a sustainable way.
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Affiliation(s)
- Michele Antonelli
- Department of Medicine and Surgery, Institute of Public Health, University of Parma, Parma, Italy
- Terme di Monticelli, Parma, Italy
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Schobersberger W, Blank C, Budgett R, Pipe A, Stuart MC. Compliance with needle-use declarations at two Olympic Winter Games: Sochi (2014) and PyeongChang (2018). Br J Sports Med 2019; 54:27-32. [DOI: 10.1136/bjsports-2018-100342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2019] [Indexed: 11/04/2022]
Abstract
ObjectivesWe describe compliance with the ‘IOC Needle Policy’ at two Winter Olympic Games (Sochi and PyeongChang) and compare these findings to those of the Summer Olympic Games of Rio de Janeiro.MethodAll needle-use declaration(s) (NUD) received during the course of the 2014 and 2018 Olympic Games were reviewed. We recorded socio-demographic data, the nature and purpose of needle use, product(s) injected, and route of administration. Data were analysed descriptively.ResultsIn total, doctors from 22 National Olympic Committees (NOCs) submitted 122 NUD involving 82 athletes in Sochi; in PyeongChang, doctors from 19 NOCs submitted 82 NUD involving 61 athletes. This represented approximately 2% of all athletes at both Games, and 25% and 20% of all NOCs participating in Sochi and PyeongChang, respectively. No marked differences in the NUD distribution patterns were apparent when comparing the two Winter Olympic Games. The most commonly administered substances were as follows: local anaesthetics, non-steroidal anti-inflammatory drug and glucocorticoids. Physicians submitted multiple NUD for 24% of all athletes who required a NUD.ConclusionA limited number of NOCs submitted NUD suggesting a low incidence of needle use or limited compliance (approximately 2%). A key challenge for the future is to increase the rate of compliance in submitting NUD. More effective education of NOCs, team physicians and athletes regarding the NUD policy, its purpose, and the necessity for NUD submissions, in association with the enforcement of the appropriate sanctions following non-compliance are needed.
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Hümmer H, Wiecken T, Pachmann K. [Unmittelbare Remission eines mit großzelligem B-Non-Hodgkin-Lymphom befallenen inguinalen Lymphknotens unter alleiniger homöopathischer Behandlung mit Conium: Wann ist eine alleinige adjuvant-homöopathische Tumortherapie zulässig und sinnvoll?]. Complement Med Res 2019; 26:361-366. [PMID: 31104055 DOI: 10.1159/000500122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/05/2019] [Indexed: 11/19/2022]
Abstract
Bei einer 63-jährigen Patientin wird mittels Biopsie eines linksinguinalen Lymphknotens ein großzelliges B-Non-Hodgkin-Lymphom diagnostiziert. Unmittelbar nach Beginn einer homöopathischen Therapie mit Conium C 30 beginnt sich der Lymphknoten in der linken Leiste zurückzubilden. Bei Exzision des Lymphknotens vierzehn Tage nach Therapiebeginn können histologisch keine Residuen des Tumors mehr nachgewiesen werden und es darf von einer vollständigen Remission ausgegangen werden. Die Patientin bleibt in der Folge rezidivfrei. Das homöopathische Mittel Conium (Schierling) kommt in der adjuvanten homöopathischen Tumortherapie und bei vergrößerten Lymphknoten als häufig indiziertes Mittel zur Anwendung. A large-cell B-cell non-Hodgkin Lymphoma (LCBCL) was diagnosed bioptically in a female patient (age 63 years) in one left inguinal lymph node. Immediately after beginning homeopathic treatment with Conium C 30, the lymph node started to show a reduction in size. Two weeks after starting homeopathic therapy, histological examination of the excised lymph node showed no evidence of a residual tumor – suggestive of a complete remission. The patient remains disease free until now. The homeopathic remedy Conium (hemlock) is frequently applied for adjuvant homeopathic tumor therapy as well as for the treatment of enlarged lymph nodes.
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Affiliation(s)
- Heinrich Hümmer
- Praxis für Allgemeinmedizin Dr. Wiecken - Dr. Wolf - Dr. Hümmer, Herrsching, Deutschland,
| | - Timm Wiecken
- Praxis für Allgemeinmedizin Dr. Wiecken - Dr. Wolf - Dr. Hümmer, Herrsching, Deutschland
| | - Katharina Pachmann
- Praxis für Allgemeinmedizin Dr. Wiecken - Dr. Wolf - Dr. Hümmer, Herrsching, Deutschland
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