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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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Pannek J, Pannek-Rademacher S. Time to say good-bye? Homeopathy, skeptics and thoughts on how to proceed. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2023; 20:289-291. [PMID: 33957710 DOI: 10.1515/jcim-2020-0491] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Although homeopathy is frequently used by many health professionals, there are ongoing debates concerning its effectiveness. Currently no unifying explanation how homeopathy works exists. Homeopaths are frequently challenged by skeptics, and in public opinion, the swan song for homeopathy is frequently sung. CONTENT Regarding the efficacy of homeopathy, several well-designed RCTs, observational studies, case studies, and case reports, have been published, demonstrating its clinical efficacy. Regarding its mode of action, the discovery of the working principle of homeopathy would be a major advance towards a thorough scientific recognition of homeopathy. Basic research has already discovered some milestones, e.g., significant and reproducible effects of homeopathic preparations in plants. SUMMARY To overcome the distrust of skeptics and public opinion, the support of basic research is indispensable. Second, homeopaths should continue to design prospective randomized clinical studies in order to create robust clinical evidence for the efficacy of homeopathy. Third, they should continue to publish their treatment outcomes, as these publications document clinical effectiveness beyond doubts about its mode of action. OUTLOOK These measures will not only support homeopaths in continuing their clinical work, but may lead to a better recognition of this treatment in both the scientific world and the public.
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Affiliation(s)
- Jürgen Pannek
- Neuro-Urologie, Schweizer Paraplegiker-Zentrum, Nottwil, Switzerland
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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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Frass M, Lechleitner P, Gründling C, Pirker C, Grasmuk‐Siegl E, Domayer J, Hochmair M, Gaertner K, Duscheck C, Muchitsch I, Marosi C, Schumacher M, Zöchbauer‐Müller S, Manchanda RK, Schrott A, Burghuber O. Homeopathic Treatment as an Add-On Therapy May Improve Quality of Life and Prolong Survival in Patients with Non-Small Cell Lung Cancer: A Prospective, Randomized, Placebo-Controlled, Double-Blind, Three-Arm, Multicenter Study. Oncologist 2020; 25:e1930-e1955. [PMID: 33010094 PMCID: PMC8108047 DOI: 10.1002/onco.13548] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/28/2020] [Indexed: 01/14/2023] Open
Abstract
LESSONS LEARNED Conventional medicine and homeopathy work well together. Quality of life improves with additive homeopathy in patients with non-small cell lung cancer (NSCLC). Survival improves with additive homeopathy in patients with NSCLC. BACKGROUND Patients with advanced non-small cell lung cancer (NSCLC) have limited treatment options. Alongside conventional anticancer treatment, additive homeopathy might help to alleviate side effects of conventional therapy. The aim of the present study was to investigate whether additive homeopathy might influence quality of life (QoL) and survival in patients with NSCLC. METHODS In this prospective, randomized, placebo-controlled, double-blind, three-arm, multicenter, phase III study, we evaluated the possible effects of additive homeopathic treatment compared with placebo in patients with stage IV NSCLC, with respect to QoL in the two randomized groups and survival time in all three groups. Treated patients visited the outpatients' centers every 9 weeks: 150 patients with stage IV NSCLC were included in the study; 98 received either individualized homeopathic remedies (n = 51) or placebo (n = 47) in a double-blinded fashion; and 52 control patients without any homeopathic treatment were observed for survival only. The constituents of the different homeopathic remedies were mainly of plant, mineral, or animal origin. The remedies were manufactured by stepwise dilution and succussion, thereby preparing stable Good Manufacturing Practice grade formulations. RESULTS QoL as well as functional and symptom scales showed significant improvement in the homeopathy group when compared with placebo after 9 and 18 weeks of homeopathic treatment (p < .001). Median survival time was significantly longer in the homeopathy group (435 days) versus placebo (257 days; p = .010) as well as versus control (228 days; p < .001). Survival rate in the homeopathy group differed significantly from placebo (p = .020) and from control (p < .001). CONCLUSION QoL improved significantly in the homeopathy group compared with placebo. In addition, survival was significantly longer in the homeopathy group versus placebo and control. A higher QoL might have contributed to the prolonged survival. The study suggests that homeopathy positively influences not only QoL but also survival. Further studies including other tumor entities are warranted.
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Affiliation(s)
- Michael Frass
- Medical University of Vienna, Department of Medicine I, Clinical Division of Oncology and Institute for Homeopathic ResearchViennaAustria
- Scientific Society for Homeopathy (WissHom)KoethenGermany
| | | | | | - Claudia Pirker
- Department of Respiratory and Critical Care Medicine, Respiratory Oncology Unit, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik FloridsdorfViennaAustria
| | - Erwin Grasmuk‐Siegl
- Department of Respiratory and Critical Care Medicine, Respiratory Oncology Unit, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik FloridsdorfViennaAustria
| | - Julian Domayer
- Department of Respiratory and Critical Care Medicine, Respiratory Oncology Unit, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik FloridsdorfViennaAustria
| | - Maximilian Hochmair
- Department of Respiratory and Critical Care Medicine, Respiratory Oncology Unit, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik FloridsdorfViennaAustria
| | | | - Cornelia Duscheck
- Medical University of Vienna, Department of Medicine I, Clinical Division of OncologyViennaAustria
| | - Ilse Muchitsch
- Austrian Chamber of Pharmacists, Department Vienna, HomResearch, Interdisciplinary Homeopathic Research GroupViennaAustria
| | - Christine Marosi
- Medical University of Vienna, Department of Medicine I, Clinical Division of OncologyViennaAustria
| | | | - Sabine Zöchbauer‐Müller
- Medical University of Vienna, Department of Medicine I, Clinical Division of OncologyViennaAustria
| | - Raj K. Manchanda
- Central Council for Research in Homeopathy, Ministry of AYUSH, Government of India and LMHI, West DelhiDelhiIndia
| | - Andrea Schrott
- StatistikAmbulanz, Consulting Company, LeobendorfAustria
| | - Otto Burghuber
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for Lung Health, Otto Wagner Hospital and Sigmund Freud University, Medical SchoolViennaAustria
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Reisman S, Balboul M, Jones T. P-curve accurately rejects evidence for homeopathic ultramolecular dilutions. PeerJ 2019; 7:e6318. [PMID: 30697492 PMCID: PMC6347964 DOI: 10.7717/peerj.6318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/16/2018] [Indexed: 11/20/2022] Open
Abstract
Background P-curve has been proposed as a statistical test of evidential value. The distributions of sets of statistically significant p-values are tested for skewness. P-curves of true effects are right-skewed, with greater density at lower p-values than higher p-values. Analyses of null effects result in a flat or left-skewed distribution. The accuracy of p-curve has not been tested using published research analyses of a null effect. We examined whether p-curve accurately rejects a set of significant p-values obtained for a nonexistent effect. Methods Homeopathic ultramolecular dilutions are medicinal preparations with active substances diluted beyond Avogadro's number. Such dilute mixtures are unlikely to contain a single molecule of an active substance. We tested whether p-curve accurately rejects the evidential value of significant results obtained in placebo-controlled clinical trials of homeopathic ultramolecular dilutions. Results P-curve accurately rejected the evidential value of significant results obtained in placebo-controlled clinical trials of ultramolecular dilutions. Robustness testing using alternate p-values yielded similar results. Conclusion Our results suggest that p-curve can accurately detect when sets of statistically significant results lack evidential value.
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Affiliation(s)
- Samuel Reisman
- SUNY Downstate College of Medicine, Brooklyn, NY, United States of America
| | - Mostafa Balboul
- SUNY Downstate College of Medicine, Brooklyn, NY, United States of America
| | - Tashzna Jones
- SUNY Downstate College of Medicine, Brooklyn, NY, United States of America
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Lutz B, Heer I, Katzensteiner R, Raak C, Wolf U, Heusser P, Frass M, Baumgartner S. Development of a whole plant bioassay to test effects of potentized calcium carbonate in pillule formulation. Complement Ther Med 2018; 40:13-21. [PMID: 30219438 DOI: 10.1016/j.ctim.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 05/31/2018] [Accepted: 06/13/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES From a pharmaceutical point of view, we see a need to develop stable preclinical test systems to identify and investigate effects of potentized remedies as used in Anthroposophic Medicine and Homeopathy. We evaluated a plant bioassay regarding its capacity to distinguish homeopathic remedies from placebo, applied as sucrose pillules. METHODS Pea seed (Pisum sativum L) was soaked for 24 hours in water with dissolved homeopathic or placebo pillules, or in water only. Shoot length was measured 14 days after planting and treatment groups were compared by analysis of variance (ANOVA). The stability of the system was validated by systematic negative control experiments. RESULTS The system is suitable to test a common application form - sucrose pillules - of a potentized preparation without influence of the pharmaceutical carrier substance. A screening of 13 potentized preparations revealed Calcium carbonicum to affect pea shoot growth (p < 0.05). Three independent series of main experiments were performed with potentized Calcium carbonicum to assess reproducibility. Meta-analysis of all data revealed significant effects of Calcium carbonicum 12c and 30c on pea shoot growth (p < 0.05), which were however dependent on the date of experiment and/or the experimental series. CONCLUSIONS Potentized Calcium carbonicum, applied as sucrose pillules, influenced pea shoot growth in the assay investigated. However, due to the small effect size and due to the modulation of the effects by still unknown external factors, further optimization of this bioassay is necessary to be used in pharmaceutical quality control or in investigating the biological or pharmaceutical mode of action of potentized preparations.
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Affiliation(s)
- Bianka Lutz
- Institute of Complementary Medicine, Fabrikstrasse 8, University of Bern, 3012 Bern, Switzerland; Institute of Integrative Medicine, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany; Research Institute for Organic Agriculture, Ackerstrasse, 5070 Frick, Switzerland
| | - Iris Heer
- Institute of Complementary Medicine, Fabrikstrasse 8, University of Bern, 3012 Bern, Switzerland
| | - Ramona Katzensteiner
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christa Raak
- Institute of Integrative Medicine, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
| | - Ursula Wolf
- Institute of Complementary Medicine, Fabrikstrasse 8, University of Bern, 3012 Bern, Switzerland
| | - Peter Heusser
- Institute of Integrative Medicine, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
| | - Michael Frass
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Stephan Baumgartner
- Institute of Complementary Medicine, Fabrikstrasse 8, University of Bern, 3012 Bern, Switzerland; Institute of Integrative Medicine, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany.
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Raak C, Scharbrodt W, Berger B, Büssing A, Geißen R, Ostermann T. Hypericum perforatum to improve post-operative Pain Outcome after monosegmental Spinal microdiscectomy (HYPOS): a study protocol for a randomised, double-blind, placebo-controlled trial. Trials 2018; 19:253. [PMID: 29695262 PMCID: PMC5918572 DOI: 10.1186/s13063-018-2631-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/09/2018] [Indexed: 11/28/2022] Open
Abstract
Background Spinal disc herniation is a frequently occurring degenerative disease of the spine. Many patients undergoing surgery suffer from radicular pain, known as memory pain, beginning from the third post-operative day. This results in the prescription of high-dose opioid medications. In homeopathy, Hypericum perforatum is known as a remedy for unbearable, shooting or jabbing pain especially when neural damage is involved. Reduction of pain after application of H. perforatum has been observed in previous studies. This study is aimed to investigate whether homeopathic H. perforatum in a potentisation of C200 leads to the reduction of post-operative pain and a decrease of pain medication compared to placebo. Methods/design This is a monocentric, double-blind, randomised placebo-controlled trial conducted at the Department of Neurosurgery at the Community Hospital Herdecke, Germany. One hundred study participants are being recruited from inpatients undergoing elective, monosegmental, lumbar microdiscectomy surgery. Patients are randomly allocated to receive homeopathic treatment or placebo in addition to usual pain management after surgery. The primary clinical outcome is pain reduction after 3 days of inpatient care as measured by pain reduction of subjective pain on a 100-mm Visual Analogue Scale (VAS) at the third post-operative day. Statistical analysis will be carried out by means of a covariance model with adjustment for baseline values and patient expectation for all randomised patients. Discussion This study is the first trial of classical homeopathy that will evaluate the efficacy of homeopathic H. perforatum after monosegmental spinal microdiscectomy. We intend to clarify the potential of homoeopathic H. perforatum to reduce surgery-associated pain. Trial registration German Clinical Trials Register, ID: DRKS00007913. Registered on 17 October 2014. EudraCT – Nr: 2013–001383-31. Data sets from the German Clinical Trials Register (DRKS, Deutsches Register Klinischer Studien) are updated every 4 weeks automatically to the International Clinical Trials Registry Platform of World Health Organisation: http://apps.who.int/trialsearch/. Responsibilities Sponsor: Witten/Herdecke University Alfred-Herrhausen-Straße 50 58,448 Witten Deputy of the sponsor: Dr. Wolfgang Eglmeier (Head of Centre for Clinical Trials Witten/Herdecke) Alfred-Herrhausen-Straße 50 58,448 Witten E-mail: wolfgang.eglmeier@uni-wh.de Principal investigator: Prof. Dr. med. Wolfram Scharbrodt Community Hospital Herdecke Department for Neurosurgery Gerhard-Kienle-Weg 4 58,313 Herdecke w.scharbrodt@gemeinschaftskrankenhaus.de Project coordination: Christa Raak Faculty for Health (Department for Integrative and Anthroposophic Medicine) University Witten/Herdecke gGmbh Gerhard-Kienle-Weg 4 58,313 Herdecke christa.raak@uni-wh.de Project manager/data analysis/biometry: Prof. Dr. Thomas Ostermann Faculty for Health (Department for Psychology and Psychotherapy) University Witten/Herdecke gGmbh Alfred-Herrhausen-Straße 50 58,448 Witten thomas.ostermann@uni-wh.de Electronic supplementary material The online version of this article (10.1186/s13063-018-2631-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christa Raak
- Institute of Integrative Medicine, Witten/Herdecke University, 58313 Herdecke, Germany.
| | - Wolfram Scharbrodt
- Integrative Neuromedicine, Community Hospital Herdecke, Witten/Herdecke University, 58313, Herdecke, Germany
| | - Bettina Berger
- Institute of Integrative Medicine, Witten/Herdecke University, 58313 Herdecke, Germany
| | - Arndt Büssing
- Institute of Integrative Medicine, Witten/Herdecke University, 58313 Herdecke, Germany
| | - René Geißen
- Centre for Clinical Trials, Witten/Herdecke University, 58448 Witten, Germany
| | - Thomas Ostermann
- Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, 58448 Witten, Germany
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Mathie RT, Van Wassenhoven M, Rutten ALB, Klein-Laansma CT, Eizayaga J, Pla I Castellsagué A, Jong MC, Manchanda RK, Dantas F, Oberbaum M, Frye J, Roniger H, Baumgartner S, van Haselen R, Nicolai T, Fisher P. Model validity of randomised placebo-controlled trials of non-individualised homeopathic treatment. HOMEOPATHY 2017; 106:194-202. [PMID: 29157469 DOI: 10.1016/j.homp.2017.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/23/2017] [Accepted: 07/31/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The comprehensive systematic review of randomised placebo-controlled trials (RCTs) in homeopathy requires examination of a study's model validity of homeopathic treatment (MVHT) as well as its risk of bias (extent of reliable evidence). OBJECTIVE To appraise MVHT in those RCTs of non-individualised homeopathy that an associated investigation had judged as 'not at high risk of bias'. DESIGN Systematic review. METHODS An assessment of MVHT was ascribed to each of 26 eligible RCTs. Another 49 RCTs were ineligible due to their high risk of bias. MAIN OUTCOME MEASURES MVHT and the prior risk of bias rating per trial were merged to obtain a single overall quality designation ('high', 'moderate', 'low'), based on the GRADE principle of downgrading. RESULTS The trials were rated as 'acceptable MVHT' (N = 9), 'uncertain MVHT' (N = 10) and 'inadequate MVHT' (N = 7); and, previously, as 'reliable evidence' (N = 3) and 'non-reliable evidence' (N = 23). The 26 trials were designated overall as: 'high quality' (N = 1); 'moderate quality' (N = 18); 'low quality' (N = 7). CONCLUSION Of the 26 RCTs of non-individualised homeopathy that were judged 'not at high risk of bias', nine have been rated 'acceptable MVHT'. One of those nine studies was designated 'high quality' overall ('acceptable MVHT' and 'reliable evidence'), and is thus currently the only reported RCT that represents best therapeutic practice as well as unbiased evidence in non-individualised homeopathy. As well as minimising risk of bias, new RCTs in this area must aim to maximise MVHT and clarity of reporting.
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Affiliation(s)
- Robert T Mathie
- Homeopathy Research Institute, 142 Cromwell Road, London SW7 4EF, UK.
| | - Michel Van Wassenhoven
- Belgian Homeopathic Medicines Registration Committee, FAMHP (Federal Agency for Medicines and Health Products), Belgium.
| | | | | | - José Eizayaga
- Department of Homeopathy, Maimonides University, Buenos Aires, Argentina.
| | | | - Miek C Jong
- Department Nutrition & Health, Louis Bolk Institute, Driebergen, The Netherlands; Department of Health Sciences, Mid-Sweden University, Sundsvall, Sweden; National Information and Knowledge Centre for Integrative Medicine, The Netherlands.
| | | | - Flávio Dantas
- Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil.
| | | | - Joyce Frye
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Helmut Roniger
- Royal London Hospital for Integrated Medicine, London, UK.
| | | | | | | | - Peter Fisher
- Royal London Hospital for Integrated Medicine, London, UK.
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Icard BL, Rubio E. The role of mucoactive agents in the mechanically ventilated patient: a review of the literature. Expert Rev Respir Med 2017; 11:807-814. [PMID: 28737047 DOI: 10.1080/17476348.2017.1359090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The management of airway secretions in the mechanically ventilated patient is a routine task throughout all intensive care units. The current treatment strategies are primarily based on anecdotal experiences rather than statistical evidence. Areas covered: This review article evaluates the data from published trials surrounding mucoactive agents and their use in the critically ill patient population. We completed an extensive search through PUBMED and CINAHL via EBSCO, along with the Cochran library to find all trials using mucoactive agents in the critically ill patient population. Expert commentary: Overall, the role of mucoactive agents in the intensive care unit is a field within pulmonary critical care that is in need of evidence-based recommendations. We feel that there is great opportunity for investigators to evaluate different mucoactive therapies in this patient population and to determine their effect on clinical outcomes.
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Affiliation(s)
- Bradley L Icard
- a Department of Pulmonary, Critical Care, and Sleep Medicine , Carilion Clinic - Virginia Tech Carilion School of Medicine , Roanoke , VA , USA
| | - Edmundo Rubio
- a Department of Pulmonary, Critical Care, and Sleep Medicine , Carilion Clinic - Virginia Tech Carilion School of Medicine , Roanoke , VA , USA
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Estores IM, Frye J. Healing Environments: Integrative Medicine and Palliative Care in Acute Care Settings. Crit Care Nurs Clin North Am 2015; 27:369-82. [PMID: 26333757 DOI: 10.1016/j.cnc.2015.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Conventional medicine is excellent at saving lives; however, it has little to offer to address the physical, mental, and emotional distress associated with life-threatening or life-limiting disease. An integrative approach to palliative care in acute care settings can meet this need by creating healing environments that support patients, families, and health care professionals. Mindful use of language enhances the innate healing response, improves communication, and invites patients and families to participate in their care. Staff should be offered access to skills training to cultivate compassion and mindful practice to enhance both patient and self-care.
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Affiliation(s)
- Irene M Estores
- Integrative Medicine Program, Division of General Internal Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
| | - Joyce Frye
- Pharmacopeia Revision Committee, Homeopathic Pharmacopeia Convention of the United States, Baltimore, MD, USA
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Abstract
PURPOSE OF REVIEW To provide a comprehensive review of complementary and alternative medicine (CAM) therapies for the treatment of pulmonary disorders in children. RECENT FINDINGS The use of complementary medicine (CAM) is commonly used by both children and adults with breathing problems, and especially in chronic pulmonary disorders such as asthma and cystic fibrosis. Many clinics and hospitals now offer CAM, even though most of the conventionally trained health practitioners have little knowledge or education regarding CAM therapies. Research in CAM that demonstrates overall benefit is lacking, especially in children. Often parents do not report CAM use to their child's healthcare provider and this could compromise their overall quality of care. Although many research studies evaluating CAM therapies have methodological flaws, data exist to support CAM therapies in treating children with pulmonary disorders. SUMMARY This review examines the latest evidence of CAM use and effectiveness in children with pulmonary disorders. Physicians should be aware of the many CAM therapy options and the research surrounding them in order to provide their patients with the most current and accurate information available.
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Majewsky V, Scherr C, Arlt SP, Kiener J, Frrokaj K, Schindler T, Klocke P, Baumgartner S. Reproducibility of effects of homeopathically potentised gibberellic acid on the growth of Lemna gibba L. in a randomised and blinded bioassay. HOMEOPATHY 2014; 103:113-26. [PMID: 24685416 DOI: 10.1016/j.homp.2013.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 12/23/2013] [Accepted: 12/23/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Reproducibility of basic research investigations in homeopathy is challenging. This study investigated if formerly observed effects of homeopathically potentised gibberellic acid (GA3) on growth of duckweed (Lemna gibba L.) were reproducible. METHODS Duckweed was grown in potencies (14x-30x) of GA3 and one time succussed and unsuccussed water controls. Outcome parameter area-related growth rate was determined by a computerised image analysis system. Three series including five independent blinded and randomised potency experiments (PE) each were carried out. System stability was controlled by three series of five systematic negative control (SNC) experiments. Gibbosity (a specific growth state of L. gibba) was investigated as possibly essential factor for reactivity of L. gibba towards potentised GA3 in one series of potency and SNC experiments, respectively. RESULTS Only in the third series with gibbous L. gibba L. we observed a significant effect (p = 0.009, F-test) of the homeopathic treatment. However, growth rate increased in contrast to the former study, and most biologically active potency levels differed. Variability in PE was lower than in SNC experiments. The stability of the experimental system was verified by the SNC experiments. CONCLUSIONS Gibbosity seems to be a necessary condition for reactivity of L. gibba to potentised GA3. Further still unknown conditions seem to govern effect direction and the pattern of active and inactive potency levels. When designing new reproducibility studies, the physiological state of the test organism must be considered. Variability might be an interesting parameter to investigate effects of homeopathic remedies in basic research.
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Affiliation(s)
- Vera Majewsky
- Institute of Complementary Medicine, University of Berne, Insel-Spital, Imhoof-Pavillon, 3010 Bern, Switzerland; Clinic for Animal Reproduction, Faculty of Veterinary Medicine, Freie Universität Berlin, Königsweg 65 (Haus 27, Gebäude 19), 14163 Berlin, Germany; Research Institute of Organic Agriculture FiBL, Ackerstrasse, Postfach, 3070 Frick, Switzerland.
| | - Claudia Scherr
- Institute of Complementary Medicine, University of Berne, Insel-Spital, Imhoof-Pavillon, 3010 Bern, Switzerland; Hiscia Institute, Society for Cancer Research, Kirschweg 9, 4144 Arlesheim, Switzerland
| | - Sebastian Patrick Arlt
- Clinic for Animal Reproduction, Faculty of Veterinary Medicine, Freie Universität Berlin, Königsweg 65 (Haus 27, Gebäude 19), 14163 Berlin, Germany
| | - Jonas Kiener
- Research Institute of Organic Agriculture FiBL, Ackerstrasse, Postfach, 3070 Frick, Switzerland
| | - Kristina Frrokaj
- Research Institute of Organic Agriculture FiBL, Ackerstrasse, Postfach, 3070 Frick, Switzerland
| | - Tobias Schindler
- Research Institute of Organic Agriculture FiBL, Ackerstrasse, Postfach, 3070 Frick, Switzerland
| | - Peter Klocke
- Research Institute of Organic Agriculture FiBL, Ackerstrasse, Postfach, 3070 Frick, Switzerland; Bovicare GmbH, Hermannswerder Haus 14, 14473 Potsdam, Germany
| | - Stephan Baumgartner
- Institute of Complementary Medicine, University of Berne, Insel-Spital, Imhoof-Pavillon, 3010 Bern, Switzerland; Hiscia Institute, Society for Cancer Research, Kirschweg 9, 4144 Arlesheim, Switzerland; Institute of Integrative Medicine, University of Witten-Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
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Klein SD, Wolf U. Investigating homeopathic verum and placebo globules with UV spectroscopy. Complement Med Res 2013; 20:295-297. [PMID: 24030453 DOI: 10.1159/000354408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Sabine D Klein
- Institute of Complementary Medicine, University of Bern, Switzerland
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Chung Y, Dumont RC. Complementary and alternative therapies: use in pediatric pulmonary medicine. Pediatr Pulmonol 2011; 46:530-44. [PMID: 21560261 DOI: 10.1002/ppul.21426] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 12/15/2010] [Accepted: 12/16/2010] [Indexed: 12/26/2022]
Abstract
With increased awareness of complementary/alternative medicine (CAM) and concern of potential adverse effects or limited effectiveness of conventional medications, patients and parents are looking to CAM approaches as either an alternative or as adjunct therapy, especially for chronic diseases such as asthma or cystic fibrosis. It is important that practitioners have adequate information so that patients and parents receive balanced and accurate information, especially regarding safety and potential efficacy. This review provides an overview of some of the more frequently used CAM therapies for children with chronic pulmonary disorders and summarizes the basic principles of each modality, along with efficacy and safety data.
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Affiliation(s)
- Youngran Chung
- Division of Pulmonary Medicine, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60614-3394, USA.
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Overend TJ, Anderson CM, Brooks D, Cicutto L, Keim M, McAuslan D, Nonoyama M. Updating the evidence-base for suctioning adult patients: a systematic review. Can Respir J 2009; 16:e6-17. [PMID: 19557211 PMCID: PMC2706678 DOI: 10.1155/2009/872921] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To update a previous clinical practice guideline on suctioning in adult patients, published in the Canadian Respiratory Journal in 2001. METHODS A primary search of the MEDLINE (from 1998), CINAHL, EMBASE and The Cochrane Library (all from 1996) databases up to November 2007, was conducted. These dates reflect the search limits reached in the previous clinical practice guideline. A secondary search of the reference lists of retrieved articles was also performed. Two reviewers independently appraised each study before meeting to reach consensus. Study quality was evaluated using the Jadad and PEDro scales. When sufficient data were available, a meta-analysis was conducted using a random effects model. Data are reported as ORs, weighted mean differences and 95% CIs. When no comparisons were possible, qualitative analyses of the data were completed. RESULTS Eighty-one studies were critically appraised from a pool of 123. A total of 28 randomized controlled trials or randomized crossover studies were accepted for inclusion. Meta-analysis was possible for open versus closed suctioning only. Recommendations from 2001 with respect to hyperoxygenation, hyperinflation, use of a ventilator circuit adaptor and subglottic suctioning were confirmed. New evidence was identified with respect to indications for suctioning, open suction versus closed suction systems, use of medications and infection control. CONCLUSIONS While new evidence continues to be varied in strength, and is still lacking in some areas of suctioning practice, the evidence base has improved since 2001. Members of the health care team should incorporate this evidence into their practice.
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Affiliation(s)
- Tom J Overend
- School of Physical Therapy, University of Western Ontario, London, Canada.
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Scherr C, Simon M, Spranger J, Baumgartner S. Effects of potentised substances on growth rate of the water plant Lemna gibba L. Complement Ther Med 2009; 17:63-70. [PMID: 19185263 DOI: 10.1016/j.ctim.2008.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 08/22/2008] [Accepted: 10/28/2008] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES This study investigated, whether the growth rate of Lemna gibba L. (duckweed) can be influenced by the application of homeopathic potencies of gibberellic acid, kinetin, argentum nitricum, and lemna minor. METHODS Duckweed was grown in either potencies (14x-30x, decimal steps) or water controls (unsuccussed and succussed) over seven days. Frond (leaf-like structure) growth was measured using a non-destructive image analysis system. Growth rates were calculated for three time intervals (0-7, 0-3, 3-7 days). Five to six independent, randomized and blinded experiments were analysed for each of the four tested substances. Water control experiments were performed repeatedly to test the reliability of the experimental set-up (systematic negative controls). RESULTS The systematic negative control experiments did not yield any significant effects. Hence, false positive results could be excluded. The test system had a low coefficient of variation (1.5%). Out of the four tested substances gibberellic acid had the most pronounced effect (p=0.0002, F-test) on the main outcome parameter frond growth rate (r(area) day 0-7). Potency levels 15x, 17x, 18x, 23x and 24x reduced growth rate of Lemna gibba (p<0.05 against the pooled water control, LSD test). CONCLUSIONS Lemna gibba may be considered as a suitable test organism for further studies on the efficacy of homeopathic potencies. Evidence accumulates, that adjacent potency levels may strongly differ in their biological activity. Potential consequences for therapeutical application might be worth investigating.
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Affiliation(s)
- Claudia Scherr
- Research Institute of Organic Agriculture (FiBL), Ackerstrasse, Frick, Switzerland.
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Colquhoun D. Treating Critically Ill Patients With Sugar Pills. Chest 2007; 131:635-6; author reply 636. [PMID: 17296675 DOI: 10.1378/chest.06-2402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Response. Chest 2007. [DOI: 10.1016/s0012-3692(15)48361-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ullman D. Let's have a serious discussion of nanopharmacology and homeopathy. FASEB J 2007; 20:2661; author reply 2662. [PMID: 17142803 DOI: 10.1096/fj.06-1205ufm] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ullman D. Conference Report: Improving the success of homeopathy 5: A global perspective; London, January 26–27, 2006, Royal London Homoeopathic Hospital. HOMEOPATHY 2006. [DOI: 10.1016/j.homp.2006.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Oberbaum M, Singer SR, Frass M. Homeopathic research after the Lancet meta analysis--a moment for introspection. Complement Ther Med 2005; 13:303-5. [PMID: 16338202 DOI: 10.1016/j.ctim.2005.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Accepted: 10/07/2005] [Indexed: 11/30/2022] Open
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Carbert S, Venn R. Recently published papers: out with the old and in with the new ... then something new for the old! CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2005; 9:238-40. [PMID: 15987408 PMCID: PMC1175904 DOI: 10.1186/cc3723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
New therapies are challenging older, established practices. One recently published report shows us that we may be able to avoid endotracheal intubation in patients with a reduced level of consciousness. Recombinant activated factor VII is proving to be useful in many coagulation disorders, and intracerebral haemorrhage can be added to this list. Homeopathy, in the form of potassium dichromate, shows promise as a new treatment for excessive tracheal secretions. Rotation protocols for antibiotics have been evaluated with respect to their ability to prevent the development of new resistant micro-organisms in our hospitals and units. Finally, glucocorticoids may be of benefit to septic patients outside the intensive care unit (ICU) and may prevent their deterioration and admission to the ICU.
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Affiliation(s)
- Simone Carbert
- Senior House Officer, Department of Critical Care, Worthing General Hospital, Worthing, UK
| | - Richard Venn
- Consultant, Department of Critical Care, Worthing General Hospital, Worthing, UK
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