Integrating homoeopathy in health systems.
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Homoeopathy is a therapy which involves many components and three main agents: the patient, with his or her condition and personal characteristics; the medication used, with its composition and manufacturing procedure; and the physician, with his or her approach to treatment and concepts of health. The development of research and evaluation structures, combined with a critical education in the discipline, would help to improve practices and define homoeopathy's potential role in relation to the other therapies, both conventional and unconventional, used in Western health systems. (+info)
Randomized double-blind placebo-controlled trial of homoeopathic 'proving' for Belladonna C30.
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Homoeopathic drug pictures are developed by recording the symptomatic effects of homoeopathic remedies given to healthy volunteers (a 'proving'). In a double-blind randomized controlled trial we tested the hypothesis that individuals using an infinitesimal dilution of Belladonna (thirtieth potency, C30) would record more true symptoms, on a questionnaire that contained both true and false Belladonna proving symptoms, than those receiving placebo. 60 volunteers entered the study and 47 completed data collection. We were unable to distinguish between Belladonna C30 and placebo using our primary outcome measure. For the secondary outcome measure we analysed the number of individuals who proved to the remedy according to our predefined criteria: 4 out of 19 proved in the Belladonna C30 group and 1 out of 27 in the placebo group (difference not statistically significant). This pilot study does not demonstrate a clear proving reaction for Belladonna C30 versus placebo, but indicates how the question might be further investigated. (+info)
A randomized controlled trial comparing topical piroxicam gel with a homeopathic gel in osteoarthritis of the knee.
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OBJECTIVE: : To evaluate the efficacy and safety of a homeopathic gel vs an NSAID (piroxicam) gel in the treatment of osteoarthritis of the knee. METHOD: : One hundred and eighty-four out-patients with radiographically confirmed symptomatic osteoarthritis of the knee were entered into a pragmatic, randomized, double-blind controlled trial and treated with 1 g of gel three times daily for 4 weeks. Main outcome measures were pain on walking as a Visual Analogue Score (VAS) and a single-joint Ritchie index. RESULTS: : One hundred and seventy-two of the 184 enrolled patients had endpoints for the main outcome parameters. The pain reduction was 16.5 mm VAS in the homeopathy group (n = 86) and 8.1 mm in the piroxicam group (n = 86); the difference between treatment groups was 8.4 mm (95% confidence interval 0.8-15.9), and after adjustment for pain at baseline it was 6.8 mm (95% confidence interval -0.3 to 13.8). There was no significant difference between treatment groups in the single-joint Ritchie index (P = 0.78). Adverse events occurred in 28 patients (12 homeopathy group, 5 withdrawn; 16 piroxicam group, 9 withdrawn); 18 of the events involved a local reaction (7 homeopathy group, 2 withdrawn; 11 piroxicam group, 5 withdrawn). CONCLUSION: : The homeopathic gel was at least as effective and as well tolerated as the NSAID gel. The presence of a clinically relevant difference between treatment groups cannot be excluded. The homeopathic gel supplemented by simple analgesics if required may provide a useful treatment option for patients with osteoarthritis. (+info)
Randomised controlled trial of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series.
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OBJECTIVE: To test the hypothesis that homoeopathy is a placebo by examining its effect in patients with allergic rhinitis and so contest the evidence from three previous trials in this series. DESIGN: Randomised, double blind, placebo controlled, parallel group, multicentre study. SETTING: Four general practices and a hospital ear, nose, and throat outpatient department. PARTICIPANTS: 51 patients with perennial allergic rhinitis. INTERVENTION: Random assignment to an oral 30c homoeopathic preparation of principal inhalant allergen or to placebo. MAIN OUTCOME MEASURES: Changes from baseline in nasal inspiratory peak flow and symptom visual analogue scale score over third and fourth weeks after randomisation. RESULTS: Fifty patients completed the study. The homoeopathy group had a significant objective improvement in nasal airflow compared with the placebo group (mean difference 19.8 l/min, 95% confidence interval 10.4 to 29.1, P=0.0001). Both groups reported improvement in symptoms, with patients taking homoeopathy reporting more improvement in all but one of the centres, which had more patients with aggravations. On average no significant difference between the groups was seen on visual analogue scale scores. Initial aggravations of rhinitis symptoms were more common with homoeopathy than placebo (7 (30%) v 2 (7%), P=0.04). Addition of these results to those of three previous trials (n=253) showed a mean symptom reduction on visual analogue scores of 28% (10.9 mm) for homoeopathy compared with 3% (1.1 mm) for placebo (95% confidence interval 4.2 to 15.4, P=0.0007). CONCLUSION: The objective results reinforce earlier evidence that homoeopathic dilutions differ from placebo. (+info)
Clinical outcomes of a diagnostic and treatment protocol in allergy/sensitivity patients.
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OBJECTIVES: This level II outcome study was conducted to examine the efficacy and toxicity of a diagnostic and treatment protocol using electrodermal screening (EDS) in allergy/sensitivity patients. METHODS: Ninety-six patients with a diagnosis of allergy or sensitivity entered the study between 1994 and 1998; 90 participants completed the study. All participants followed the same protocol, and all interactions were with a single clinician at a single site. The Allergy Symptom Severity Index (ASSI) was developed to record symptomatic information. EDS - conductance measurement 1/( - of specific acupuncture points was used as an objective endpoint (indicator of outcome) and for identification of antigens, according to Voll criteria. All measurements were taken before and after treatment, and EDS was carried out at all treatment sessions. Outcome criteria suggesting efficacy were reduction in ASSI score, reduction in number of items testing positive, and normalization of conductance measurements. A statistical analysis of the outcomes was performed using the student's paired t-test. RESULTS: There was a statistically significant change in pre- and post-treatment measurements of the ASSI. The conductance measurements normalized and the number of items testing positive decreased compared to pre-treatment testing. In addition to these parameters, 87.2 percent of subjects rated efficacy as good to excellent, and less than one-percent rated the outcome as poor. The outcome demonstrated longevity, meaning that people who had their post-treatment evaluation up to three years after primary treatment were still showing minimal ASSI scores, with no additional treatment. The treatment appeared to work equally well across age groups and gender. Forty-eight percent of participants had an aggravation of symptoms after treatment, lasting an average of 10 hours, with reactions described as mild to moderate. Average cost of the desensitization protocol (all costs included) was $822.16. CONCLUSIONS: This protocol demonstrated efficacy without serious toxicity and no long-term adverse effects. It is natural, non-invasive, and does not require long periods of avoidance of offending foods or environmental stimuli. The desensitization protocol is a low-cost, effective therapy for the treatment of patients suffering from symptoms of allergy/sensitivity disease. (+info)
The methodological quality of randomized controlled trials of homeopathy, herbal medicines and acupuncture.
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BACKGROUND: To investigate the methodological quality of randomized controlled trials in three areas of complementary medicine. METHODS: The methodological quality of 207 randomized trials collected for five previously published systematic reviews on homeopathy, herbal medicine (Hypericum for depression, Echinacea for common cold), and acupuncture (for asthma and chronic headache) was assessed using a validated scale (the Jadad scale) and single quality items. RESULTS: While the methodological quality of the trials was highly variable, the majority had important shortcomings in reporting and/or methodology. Major problems in most trials were the description of allocation concealment and the reporting of drop-outs and withdrawals. There were relevant differences in single quality components between the different complementary therapies: For example, acupuncture trials reported adequate allocation concealment less often (6% versus 32% of homeopathy and 26% of herb trials), and trials on herbal extracts had better summary scores (mean score 3.12 versus 2.33 for homeopathy and 2.19 for acupuncture trials). Larger trials published more recently in journals listed in Medline and in English language scored significantly higher than trials not meeting these criteria. CONCLUSION: Trials of complementary therapies often have relevant methodological weaknesses. The type of weaknesses varies considerably across interventions. (+info)
Systematic reviews of complementary therapies - an annotated bibliography. Part 3: homeopathy.
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BACKGROUND: Complementary therapies are widespread but controversial. We aim to provide a comprehensive collection and a summary of systematic reviews of clinical trials in three major complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with homeopathy. Potentially relevant reviews were searched through the register of the Cochrane Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and books. To be included articles had to review prospective clinical trials of homeopathy; had to describe review methods explicitly; had to be published; and had to focus on treatment effects. Information on conditions, interventions, methods, results and conclusions was extracted using a pretested form and summarized descriptively. RESULTS: Eighteen out of 22 potentially relevant reviews preselected in the screening process met the inclusion criteria. Six reviews addressed the question whether homeopathy is effective across conditions and interventions. The majority of available trials seem to report positive results but the evidence is not convincing. For isopathic nosodes for allergic conditions, oscillococcinum for influenza-like syndromes and galphimia for pollinosis the evidence is promising while in other areas reviewed the results are equivocal. INTERPRETATION: Reviews on homeopathy often address general questions. While the evidence is promising for some topics the findings of the available reviews are unlikely to end the controversy on this therapy. (+info)
A randomized controlled trial of homeopathy in rheumatoid arthritis.
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OBJECTIVE: To test the hypothesis that homeopathy is effective in reducing the symptoms of joint inflammation in rheumatoid arthritis (RA). METHOD: This was a 6-month randomized, cross-over, double-blind, placebo-controlled, single-centre study set in a teaching hospital rheumatology out-patient clinic. The participants of the study were 112 patients who had definite or classical RA, were seropositive for rheumatoid factor and were receiving either stable doses of single non-steroidal anti-inflammatory drugs (NSAIDs) for > or =3 months or single disease-modifying anti-rheumatic drugs (DMARDs) with or without NSAIDs for > or =6 months. Patients who were severely disabled, had taken systemic steroids in the previous 6 months or had withdrawn from DMARD therapy in the previous 12 months were excluded. Two series of medicines were used. One comprised 42 homeopathic medicines used for treating RA in 6cH (10(-12)) and/or 30cH (10(-30)) dilutions (a total of 59 preparations) manufactured to French National Pharmacopoeia standards, the other comprised identical matching placebos. The main outcome measures were visual analogue scale pain scores, Ritchie articular index, duration of morning stiffness and erythrocyte sedimentation rate (ESR). RESULTS: Fifty-eight patients completed the trial. Over 6 months there were significant decreases (P<0.01 by Wilcoxon rank sum tests) in their mean pain scores (fell 18%), articular indices (fell 24%) and ESRs (fell 11%). Fifty-four patients withdrew before completing the trial. Thirty-one changed conventional medication, 10 had serious intercurrent illness or surgery, 12 failed to attend and three withdrew consent. Placebo and active homeopathy had different effects on pain scores; mean pain scores were significantly lower after 3 months' placebo therapy than 3 months' active therapy (P=0.032 by Wilcoxon rank sum test). Articular index, ESR and morning stiffness were similar with active and placebo homeopathy. CONCLUSIONS: We found no evidence that active homeopathy improves the symptoms of RA, over 3 months, in patients attending a routine clinic who are stabilized on NSAIDs or DMARDs. (+info)