posted 11/01/04

Reading assignment:     Ernst, E. (2000).  The role of complementary and alternative medicine. BMJ, 321, 1133-5.

You might be interested in the National Center for Complementary and Alternative Medicine
 
 

Ernst (2000)

• Complementary and alternative medicine is defined as "diagnosis, __________ and/or prevention which complements _____________ ___________ by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine."

Some types of alternative medicine

• Acupuncture
• Aromatherapy
• Chelation therapy
• Chiropractic
• Herbalism
• Homeopathy
• Iridology
• Massage
• Reflexology
• Spiritual healing

• Definition: an originally Chinese practice of _________ the body with _____ at specific points to cure disease or relieve pain
• Indications:  chronic pain, _______
• Risks: Tissue trauma, infections (rare)
• Benefits:  convincing evidence for nausea but not chronic pain
• Risk-Benefit Analysis:  Positive for nausea, uncertain for chronic pain

• Definition= utilizing naturally extracted ______ essences from plants to balance, harmonize and promote the health of body, mind and spirit
• Indications: various
• Risks: ________ reaction, carcinogenic potential in some oils
• Benefits: Good evidence for relaxing effects
• RBA:  uncertain

• Definition= _________ of sodium ethylenediamminetetraacetate ion to treat atherosclerosis
• Indications: Intermittent claudication—cramping ____ and _______ in legs associated with inadequate ___________
• Risks: Kidney damage, electrolyte imbalances
• Benefits: No convincing evidence
• RBA: negative

• Definition = manipulation and adjustment of body ________
• Indications: back pain
• Risks: Vertebral or carotid _________ dissection
• Benefits: Promising but not convincing evidence for acute or chronic back pain
• RBA: uncertain

• definition = use of medicinal herbs to cure disease or promote health
• Example: St John's wort
• Indications: _________
• Risks: Increased risk of bleeding, interaction with numerous drugs
• Benefits: Clear evidence that it is superior to placebo
• RBA: positive
• Example: Ginkgo biloba
• Indications: intermittent claudication
• Risks: Increased risk of _________, interaction with anticoagulants
• Benefits: Clear evidence that it is superior to placebo
• RBA: positive

• Definition= system of medical practice that treats disease by administration of ______ doses of a remedy that would in a healthy person produce ________ of the disease
• Indications:  various
• Risks: No serious direct risks of highly dilute remedies
• Benefits: No clear evidence for clinical effectiveness for any condition
• RBA: uncertain

• Definition= study of the ____ of the _____ for indication of bodily health and disease
• Diagnostic procedure
• Risks: False positive or false negative diagnosis
• Benefits: No convincing evidence
• RBA: negative

• Definition = manipulation of _____ by rubbing, stroking, kneading for remedial or hygenic purposes.
• Indications: __________
• Risks: No serious direct risks
• Benefits: No convincing evidence
• RBA: uncertain

• Definition = manipulating _____ and ______ to restore or promote health
• Indications: various
• Risks: No serious direct risks
• Benefits: No convincing evidence for clinical effectiveness for any condition
• RBA: uncertain

• Definition = prayer, laying on of hands, etc.
• Indications: various
• Risks: No serious direct risks
• Benefits: No convincing evidence for clinical effectiveness for any condition
• RBA: uncertain

Unusual treamtent intervention:

Leibovici, L. (2001).  Beyond science? Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised controlled trial.  BMJ 2001;323:1450-1451 ( 22-29 December )

Objective: To determine whether remote, retroactive intercessory prayer, said for a group of patients with a bloodstream infection, has an effect on outcomes.
Design: Double blind, parallel group, randomised controlled trial of a retroactive intervention.
Setting: University hospital.
Subjects: All 3393 adult patients whose bloodstream infection was detected at the hospital in 1990-6.
Intervention: In July 2000 patients were randomised to a control group and an intervention group. A remote, retroactive intercessory prayer was said for the well being and full recovery of the intervention group.
Main outcome measures: Mortality in hospital, length of stay in hospital, and duration of fever.
Results: Mortality was 28.1% (475/1691) in the intervention group and 30.2% (514/1702) in the control group (P for difference=0.4). Length of stay in hospital and duration of fever were significantly shorter in the intervention group than in the control group (P=0.01 and P=0.04, respectively).
Conclusions: Remote, retroactive intercessory prayer said for a group is associated with a shorter stay in hospital and shorter duration of fever in patients with a bloodstream infection and should be considered for use in clinical practice.
 

• Participants:  the 3,393 adults patients diagnosed with blood infection between 1990-1996 at an Israeli hospital.
• Design:  Participants randomly assigned to one of two groups in July 2000.  The first names of those in the intervention group were given to a person who said a short prayer for their recovery.
• Mortality rate (p=.4)

• Length of Hospital Stay (days) (p<.01)

• Duration of Fever (days) (p<.04)

History of Homeopathy

• Founded by Samuel __________  (1755-1843)
• Criticized school of __________  (regular physicians) for current practices of ____________ and emetics
• Found that cinchona bark (which relieves fever) itself produces fever
• Conducted provings to test effects of medications on healthy subjects
• 3 principles of homeopathy
1. Similia similibus -- ______cures __________: The cure must produce _________________
2. Law of ______________
• Body more sensitive to substances when ill
• Recommended dilutions of ___________
• Spirit of the drug remains even in _____________
3. Doctrine of psora (or ______): All natural chronic disorders are manifestations of ________- (e.g., cancer, asthma, mental disturbance)
• Homeopathy becomes widespread in the US at the time of ___________
• Homeopaths form their own schools, since they alienate regular physicians
• Homeopathys success due to:
• Homeopaths operate _________________
• Most were originally trained as ___________ physicians
• Regular physicians weren't producing any better patient outcomes than homeopaths
• Homeopaths incorporated new knowledge about ___________, even though it contradicted their dogma.
• Homeopathy is eventually subsumed into _______________.

Kainz, J. T., Kozel, G., Haidvogl, M., Smolle, J., "Homoeopathic versus placebo therapy of children with warts on the hands: a randomized, double-blind clinical trial, " Dermatology, vol. 193, pp. 318-20, 1996.

• BACKGROUND: Despite the wide practical application of homoeopathy, scientific proof of its effectiveness and mechanisms is still lacking, and sound, placebo-controlled studies are scarce.
• OBJECTIVE: The purpose of our study was to evaluate the efficacy of homoeopathy in a prospective, double-blind randomized trial.
• METHODS: 60 children aged 6-12 years with common warts on the back of the hands were treated either with an individually selected homoeopathic preparation (n = 30) of at least a 1:1,012 dilution or with pure placebo in the form of saccharose globuli (n = 30) under double-blind conditions. The area occupied by warts was measured by computerized planimetry before and after 8 weeks of treatment. Reduction of the warty area by at least 50% was considered a response.
• RESULTS: There were a total of 16 responders: 9 of 30 patients in the homoeopathic therapy group and 7 of 30 patients in the placebo group (chi 2 = 0.34, p = 0.56). Total cure of warts occurred in 5 patients in the treated group and in 1 patient in the placebo group (chi 2 = 1.46, p = 0.22).
• CONCLUSION: There was no apparent difference between the effects of homoeopathic therapy and placebo in children with common warts under the conditions of this study.

Gilovich, T. (1991). How We Know What Isn't So

• The need to try something, when other treatments have failed.
• Plus, better to try with a positive attitude.
• ________________ recoveries
• Illnesses often go away on their own
• Recovery gets attributed to the preceding treatment
• Treatments often given when patient is ______________
• Likely to get better at that point because of ___________________
• Explain away failure
• Patient didn't _________________
• Practitioner didn't administer the treatment correctly
• ____________-defined outcomes
• Unconventional treatments touted as improving well-being, overall health
• Even clinical studies use subjective outcomes like pain and depression, which could be subject to __________effects
• Seldom use __________ outcomes like ___________________
• ___________ plausibility of some treatments
• Diet high in _____ to treat arthritis
• Cleanse the body with _______________

• Pros
• Cons