tom o'brien's List: cam-research

• Evaluating integrated healthcare delivery models: a holistic approach
• the concept of integration is not new and not limited to CAM. For example, Way and Jones’ definition of collaborative practice as ‘an inter-professional process for communication and decision-making that enables the separate and shared knowledge and skills of care providers to synergistically influence the client/patient care provided’
• Integrated health care (while the terms medicine and health care are currently used interchangeably, we prefer the term integrated health care rather than medicine; the former is defined as ‘all services, products and activities used by individuals for the purpose of promoting, maintaining, monitoring or restoring health’

  • I think the essential relevant point in the use of the term integrated health care is that it shares an undertanding of the complementarity of different treatment therapeutics and an awareness of the multiple determinants of health, illness and individualised approaches to managed care.
• Ideally, integrated health care would, whenever possible, be assessed by means of an RCT to control for bias and enhance internal validity.
• The intent of classical explanatory RCTs is to demonstrate specific effects over and above non-specific or synergistic effects. The latter are, however, vital to integrated health care

  • an important point for cam research ==non-specific effects tend to be individual and influenced by the mind-body connections which include 'met-needs' experiences which can sustain specific effects of interventions.
• Descriptive research
• Chart reviews at the TCI have identified that the patient population consists of people with complex health histories and multiple stressors in their lives.
• An important issue in outcomes research is the choice of appropriate outcome measures
• Much could be gained from a systematic qualitative analysis of patients’ goals and assessment of the circumstances in which these goals are being met or changed. This could lead to the development of an instrument that has a standardised as well as a qualitative component.
• There is no best method.

  • in cam research a best method integrates quantitve and qualitive research

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• Many physicians do not understand why large segments of their patients use CAM when research generally has failed to provide decisive evidence of efficacy. Patients seem to make these treatment choices based on the qualities of the provider, desire for "individualized" treatments, and their perception of overall effectiveness rather than efficacy [7-11].
• Explore the strengths and weaknesses of conventional biomedical research strategies and methods as applied to CAM

• Why is a different research strategy needed?

   

  In conventional medicine we rarely question the efficacy or effectiveness of the overall therapeutic approach to the treatment of sick people. We take for granted that seeking advice from a health care professional is a good way of dealing with diverse health problems. Research in conventional medicine therefore focuses on choosing the best tools for health professionals to use. These tools include drugs, diagnostic methods, and surgical procedures, and employ a methodology often resulting in a one-size-fits-all therapeutic prescription. Conventional research may, however, have overlooked that the clinical effect of most therapies are overestimated when studied under optimal circumstances on susceptible, cooperative patients. Despite this, the randomized controlled trial is an important method when making decisions about tools to include in the toolbox of conventional medicine.

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• The methodological quality of randomized controlled trials of homeopathy, herbal medicines and acupuncture
• From our experience a major problem with all formal assessments of quality—be it by scales or by single quality components —is that they are very crude and mainly an assessment of reporting quality
• For example, double-blinding is more difficult for physical interventions like acupuncture than for drug interventions like homeopathy or herbs.
• However, they seem to suggest that the average methodological quality of the complementary medicine trials reviewed is not necessarily worse than that of trials in conventional medicine.

  • quality of cam research trials is improving
• People undertaking randomized trials on acupuncture should make sure that they use adequate methods for concealment of allocation. The adoption of the CONSORT guidelines²⁶ for reporting would allow much more reliable assessment of methodological quality in future systematic reviews.

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• About half the general population in developed countries uses complementary and alternative medicine

• Laboratory Research in Homeopathy: Pro

• Many women consult homeopaths for problems
  associated with the menopause e.g. hot flushes,
  night sweats, fatigue, anxiety, depression, mood
  swings, lack of confidence, vaginal dryness, and
  joint pain. A recent audit of patients receiving
  treatment from medically qualified homeopaths at
  five NHS homeopathic hospitals reported that the
  menopause was the third most common reason for
  patients to be referred for treatment (Thompson et
  al., 2008) and a study of professional homeopaths
  reported that 12.3 % of patients requested
  treatment for female complaints (Relton et al.,
  2006) - tom o'brien on 2009-07-25

• wow - tom o'brien on 2009-07-25

• In 1991, three professors of medicine from the Netherlands, none of them homeopaths, performed a meta-analysis of 25 years of clinical studies using homeopathic medicines and published their results in the British Medical Journal.⁴ This meta-analysis covered 107 controlled trials, of which 81 showed that homeopathic medicines were effective, 24 showed they were ineffective, and 2 were inconclusive.

  The professors concluded, "The amount of positive results came as a surprise to us." Specifically, they found that:

  • 13 of 19 trials showed successful treatment of respiratory infections,
  • 6 of 7 trials showed positive results in treating other infections,
  • 5 of 7 trials showed improvement in diseases of the digestive system,
  • 5 of 5 showed successful treatment of hay fever,
  • 5 of 7 showed faster recovery after abdominal surgery,
  • 4 of 6 promoted healing in treating rheumatological disease,
  • 18 of 20 showed benefit in addressing pain or trauma,
  • 8 of 10 showed positive results in relieving mental or psychological problems, and
  • 13 of 15 showed benefit from miscellaneous diagnoses.

• A recent clinical trial evaluating homeopathic medicine was a unique study of the treatment of asthma.⁶ Researchers at the University of Glasgow used conventional allergy testing to discover which substances these asthma patients were most allergic to. Once this was determined, the subjects were randomized into treatment and placebo groups. Those patients chosen for treatment were given the 30c potency of the substance to which they were most allergic (the most common substance was house dust mite). The researchers called this unique method of individualizing remedies "homeopathic immunotherapy" (homeopathic medicines are usually prescribed based on the patient's idiosyncratic symptoms, not on laboratory analysis or diagnostic categories). Subjects in this experiment were evaluated by both homeopathic and conventional physicians.

  This study showed that 82% of the patients given a homeopathic medicine improved, while only 38% of patients given a placebo experienced a similar degree of relief. When asked if they felt the patient received the homeopathic medicine or the placebo, both the patients and the doctors tended to guess correctly.