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Kate Whimster


Homeopathy literature review

Thu, 11 Mar 2010 23:43:46 +0000

A blog from my website that may be of interest here. Homeopathy is often criticized for having little research evidence available. This blog is a compilation of what I have learned in examining research evidence for homeopathy published in conventional medical journals. For more info on homeopathy, please see a previous blog entitled “Homeopathy primer.” One of the major reasons that the results of most mainstream research on homeopathy are often inconclusive because the methods used usually do not honour the principles of homeopathy and therefore the research does not actually evaluate the practice of homeopathy. Aphorism 104 in the Organon explains how a practitioner can take and treat a case homeopathically: “Once the totality of symptoms that principally determine and distinguish the disease case … has been exactly recorded, the most difficult work is done … He can then select … a well-aimed, similar, artificial disease potence, in the form of a homeopathically chosen medicinal means, to oppose the total disease image (1).” Unfortunately, remedies are often not prescribed individually and are instead selected based on typical clinical presentation of pathology. A meta-analysis published by Shang et al. in the Lancet in 2005 compared placebo-controlled homeopathy trials to conventional medicine trials matched by disorder and type and determined that “the clinical effects of homoeopathy, but not those of conventional medicine, are unspecific placebo or context effects (2).” The homeopathy trials were categorized classical, clinical, or complex homoeopathy (or as isopathy). Specifically, “Classical homoeopathy was defined as comprehensive homoeopathic history-taking, followed by the prescription of a single individualised remedy, possibly with subsequent change of remedy in response to changing symptoms. If no comprehensive homoeopathic history was taken and all patients received a single, identical remedy, interventions were classified as clinical homoeopathy (2).” Only “classical” homeopathy trials actually reflect the use of remedies according to homeopathic principles as set out in the Organon. “Clinical” homeopathy is the substitution of homeopathic remedies for conventional medicine and therefore not the practice of homeopathy. Of 110 homeopathy trials analyzed, only 18 were categorized as “classical” while 48 “clinical” homeopathy trials were analyzed. The selection of trials for this analysis therefore precluded results that would accurately evaluate the effects of homeopathic treatment. Rutten and Stolper analyzed post-publication data from the Shang paper and concluded that: “Re-analysis of Shang's post-publication data did not support the conclusion that homeopathy is a placebo effect. The conclusion that homeopathy is and that conventional is not a placebo effect was not based on comparative analysis and not justified because of heterogeneity and lack of sensitivity analysis. If we confine ourselves to the predefined hypotheses and the part of the analysis that is indeed comparative, the conclusion should be that quality of homeopathic trials is better than of conventional trials, for all trials (p=0.03) as well as for smaller trials (p=0.003) (3).” A review by Lüdtke and Rutten also came to this conclusion. Their meta-analysis determined that “homeopathy had a significant effect beyond placebo (OR=0.76; 95% CI: 0.59-0.99; p=0.039) (4).” and that, “Shang's negative results were mainly influenced by one single trial (4).” They concluded: “Shang's results and conclusions are less definite than had been presented (4).” Linde et al. published a review of randomized controlled trials of individualized homeopathy in the Lancet in 1998. In this review, the team clarified that, “in individualized homeopathy the choice of the remedy for treatment is not based on a conventional diagnosis but on the matc[...]

Is evidence-based medicine compatible with naturopathic principles?

Wed, 17 Feb 2010 10:24:51 +0000

One of the most common criticisms of natural medicine is that it lacks supportive evidence. This is simply not true! In many cases, there is as much or more research evidence for natural medicine as conventional medicine. However, there are also areas in which the research evidence is sparse or incomplete. The purpose of this blog is to clarify the true meaning of evidence-based medicine (EBM) and explore its role in contributing to natural medicine. Evidence-based medicine (EBM) is defined as the “conscientious, explicit and judicious use of current best evidence in making decisions about care of individual patients (1).” Furthermore: “The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice (1).” This definition of evidence-based medicine does not conflict with the principles of naturopathic medicine. Naturopathic medicine is based on a large body of evidence gathered through systematic research and knowledge gained through clinical experience. Its principles support the application of this information to devise the most effective treatment for our patients. However, the colloquial understanding of EBM supports randomized, double blind, placebo-controlled studies as gold standard of knowledge and leaves little room for other forms of research or for clinical experience. Conventionally understood EBM is limited in encouraging health care that adheres to naturopathic principles. First, EBM does not recognize holistic treatment of individuals, and in fact seeks to boil down complex information to a simple conclusion recognizing only how the majority of subjects respond to a single intervention. Not only does this ignore the knowledge that could be gained through examining all the subjects in a study and why they each responded in the way that they did, but also is not necessarily applicable to real life health care since patients are nearly never under controlled conditions and subject to only one intervention. Naturopathic doctors are interested in treating real patients in the real world and therefore in gathering knowledge in any area that will serve this purpose. In many cases, this knowledge includes clinical observation and experience with real patients. Second, funding committed to research is not allocated based on what areas of knowledge are the most interesting, warrant the most investigation, or even may be the most beneficial to the public. Most research is conducted by pharmaceutical companies on products they hope to bring to market in order to earn profits for shareholders. Unfortunately, this capitalist drive behind health knowledge is not conducive to researching how low-cost treatments such as diet and lifestyle changes can be far more effective than any drug. It is also not conducive to gaining knowledge through “failed” experiments, such as when pharmaceutical research does not yield results favourable to the drug being researched. Currently, pharmaceutical companies are not required to publish such research, although there is a movement to change this, thankfully. Naturopathic doctors are interested in achieving results, even if there is no particular product to sell. Finally, naturopathic doctors also act as teachers, seeking to empower patients with information so that they can care for themselves. EBM places power in a faceless research environment, removing it from clinicians with decades of experience, and therefore also removing it from individual patients who may know their unique needs best. Therefore, while the official definition of EBM does fit with naturopathic principles, the applied definition, in terms of how the health care system actually operates, does not. For more information and more of my thoughts on conventional medical research, please see my previ[...]

Another great quote and update

Tue, 21 Oct 2008 13:20:41 +0000

A quote from a few days ago, courtesy of iGoogle:

Normal is getting dressed in clothes that you buy for work and driving through traffic in a car that you are still paying for - in order to get to the job you need to pay for the clothes and the car, and the house you leave vacant all day so you can afford to live in it. - Ellen Goodman

In other news, since I am generally constantly swamped with schoolwork, I am going to write some blogs on subjects I am learning in school or have written papers about (for school!) lately. Stay tuned! The first topic will be "Iodine, Thyroid, and Breast Health".

Quote of the day

Sun, 03 Aug 2008 22:36:46 +0000

Great quote of the day from iGoogle today:

Too many people are thinking of security instead of opportunity. They seem more afraid of life than death. - James F. Byrnes