I am sorry to note that you have simplified the word science. Science is an endless effort to find out the truth. Modern Science is nothing other than to describe different things in terms of our education, perception or philosophy and explanation. It should be noted that in course of time we have changed those three things several times. I think our body is a very mysterious subject. Our current knowledge discovered some processes, some chemicals and their quantity which most of the times give some response for some abnormalities in the body. Mind it, it is not universal. Till today no one can say that he totally unveilled the body mechanisms. So I think we should not discard any belief rather to admire it because this may open a new kind of studies which is still not known to us and ultimately the Science will be enriched.
Pradyot Biswas
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This forum is not the correct forum to review the evidence base for therapies - and particularly homeopathy. Readers may however be interested to know that the oft quoted Bristol study which basically discovered that people self reported clinical improvement after an intervention. "The outcome score was assessed during the consultation, with patients
being asked to rate their overall improvement or deterioration compared
to their status at first visit."
Hardly objective, not controlled, no comparator. I imagine we could get similar data from any intervention - or even a chat with a mate over a pint.
(Spence DS, Thompson EA, Barron SJ. Homeopathic treatment for chronic
disease: a 6-year, university-hospital outpatient observational study. J Altern Complement Med 2005; 11: 793-798. (Full text available at http://www.liebertonline.com/toc/acm/11/5))
I also have to disagree with my learned colleague Mr Hardy. Whilst the results of the Kirsch paper were widely reported SSRIs as being the same efficacy as placebo this was not in fact what the authors reported not what their study showed. In fact SSRIs were consistently more effective than placebo but that this did not reach the arbitrary point for "clinical effectiveness" set by NICE in it's clinical guidelines.
May I take the liberty or recommending www.badscience.net and especially http://www.badscience.net//?p=490 as a starter on the science that may (or may not) lie behind homeopathy? Although 200 years after the therapy was invented we are still awaiting good evidence - and, despite the oft quoted percentages from BMJs Clinical Evidence most interventions actually undertaken do have a sound evidence base.
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Perhaps we should all remember that part of the Hippocratic oath which says "First do harm" and also the comment of Thomas Carlyle that "prescribing is the art of amusing the patient while nature affects a remedy".
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So, expensive placebos perceived as analgesics are effective for 85 per cent of patients while cheaper ones are only effective for 61 per cent (PJ, 21 February 2009, p195).
The authorities should take note because the implications of the placebo effect in large swathes of healthcare cannot continue to be ignored by regulators or professionals in orthodox medicine.
Complementary and alternative medicines and therapies are practically all placebos, as intimated in my letter (PJ, 9 August 2008, p160). Acceptance of the existence of two systems of healthcare — evidence-based and belief-based — should not be further delayed.
Most CAM therapies are costly, both in money and time spent with patients by practitioners. I have seen CoQ10 products in health stores at several pounds a capsule, but have never found convincing proof of medical efficacy for the substance. I am convinced that cost is an important factor for the consumer to find benefit.
More importantly, the cost to taxpayers of trying to regulate belief-based products or therapies using evidence-based criteria is huge, and allowing these on the NHS ridiculous. Let us have proper debate on these important matters forthwith because the present situation cannot continue.
In the next few months, it is expected that there will be an outcry from the CAM lobby when the European Commission announces the maximum permitted levels in vitamin and mineral supplements, but this could be an opportunity to look at CAM issues constructively.
Robert Woodward
Retired Pharmacist
Liss, Hampshire
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So, the Prince’s Foundation for Integrated Health is looking for interested pharmacists to join its network (PJ, 25 April 2009, p495). It will have more success attracting practitioners if it is less contemptuous of their mainstream role.
A major component of the foundation’s activity is, of course, complementary medicine, but it is frequently uncomplimentary about allopathic medicine. In an item published on the BBC’s news website, its medical director, Michael Dixon, described the process of integrated health: “It means treating patients as whole human beings — paying attention to body, mind and soul — instead of regarding them as nothing more than a set of symptoms to be got out the door as quickly as possible.”
Such a paternalistic view of healthcare practice is insulting and as atavistic as the preferred tastes of the Prince’s Foundation for the Built Environment.
I have no quarrel with the estimable Christine Glover, but the foundation most obviously fails the second of her four “aspects” — that of open-mindedness.
There is no clearer example of a closed mind than one which, faced with a succession of well-conducted trials where, for example, homoeopathy has failed to show benefit, refuses to entertain the notion that these data may be pointing to a genuine truth.
Much has been said in the past about the limitations of randomised clinical trials as a gold standard, but its greatest detractors are those who promote treatments that fail this first hurdle of efficacy.
Paul Hardy
Wakefield, West Yorkshire
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Thank you Graham for you correction - extreme compresion led to the false impression given by my previous posting.
P Biswas - to say that science has an incomplete understanding of the body is to state the obvious. The issue at stake here is that greater understanding will not be fostered by abandoning scientific rigour.
Alternative therapies often lie outside conventional scientific understanding of how they should work. That's fine - if they are demonstably effective then science will have to catch up.But until they are shown to deliver when measured objectively, science has no case to answer.
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Recently, I was shown a small, self-sealing plastic bag containing homoeopathic tablets with the product name, the patient’s name, the name of the clinic, and a telephone number.
I questioned the suitability of the container and the labelling (which was hand-written onto the plastic bag) with the clinic. I was informed that this type of packaging was normal and had been passed by its inspectorate. It makes me wonder if the homoeopathic industry is covered by the rules of a regulatory body to ensure compliance with health and safety regulations?
For credibility to be given to homoeopathy and homoeopathic products, clinics must supply and dispense to similar rigorous standards and regulations that are undertaken with conventional medicines. Otherwise, the whole homoeopathic industry could be labelled as irresponsible.
Bernard E. Black
Stanmore, Middlesex
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Referring to the Leading article on homoeopathy (PJ, 28 November 2009, p582), I have no concerns about homoeopathy keeping the worried well away from GPs’ consulting rooms, it is the worried sick not seeking conventional treatment that concerns me.
Norman Freedman
Northwood, Middlesex
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Most university and scientifically trained primary healthcare professionals would agree with The Journal’s statement (PJ, 28 November 2009, p582) that it does not accept homoeopathic theories, and that they are underpinned by pseudo-science and, also, in my opinion, emotion.
As taxpayers, how can the annual spend of approximately £4m on homoeopathic treatments by the NHS be justified? This expense on homoeopathic products means that £4m is not available for more clinically effective treatments.
Unfortunately, homoeopathy has powerful support in high places and in Parliament. So the profession must tread carefully in this emotive and sensitive matter. The fickle general public will only continue to support those organisations that provide them with what they require and not what the purveyors wish to supply.
This is the crux of how community pharmacy is to deal with homoeopathy, bearing in mind that the Society of Homoeopaths tells its members to avoid making claims implying homoeopathy can cure named diseases.
The profession, especially community pharmacy, must be seen to be pragmatic in the provision of homoeopathic products. In my opinion, they should be as freely available as the wide range of food supplements and vitamins are. They are complementary treatments.
Pharmacists are part of the primary care health team of professionals practising in a retail environment and, as such, my attitude is clear, unambiguous and uncomplicated: should I be presented with a homoeopathic product at an electronic point of sale, I would gladly complete the transaction, well knowing that, even if the whole bottle of tablets were to be ingested, there would no possible overdosage problems.
If, however, I were asked for my professional advice or opinion, I would clearly state that, as a professional with scientific training, I could not explain its efficacy. But with the rider, if it works, so be it.
The present movement is for the general public to be empowered to take control of their health treatments. This must surely include homoeopathic products, as well as the main stream highly promoted over-the-counter products.
J. David Thomas
Patshull, Shropshire
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Alternative Medicine
I am sorry to note that you have simplified the word science. Science is an endless effort to find out the truth. Modern Science is nothing other than to describe different things in terms of our education, perception or philosophy and explanation. It should be noted that in course of time we have changed those three things several times. I think our body is a very mysterious subject. Our current knowledge discovered some processes, some chemicals and their quantity which most of the times give some response for some abnormalities in the body. Mind it, it is not universal. Till today no one can say that he totally unveilled the body mechanisms. So I think we should not discard any belief rather to admire it because this may open a new kind of studies which is still not known to us and ultimately the Science will be enriched.
Pradyot Biswas
Homeopathy
This forum is not the correct forum to review the evidence base for therapies - and particularly homeopathy. Readers may however be interested to know that the oft quoted Bristol study which basically discovered that people self reported clinical improvement after an intervention. "The outcome score was assessed during the consultation, with patients being asked to rate their overall improvement or deterioration compared to their status at first visit."
Hardly objective, not controlled, no comparator. I imagine we could get similar data from any intervention - or even a chat with a mate over a pint.
(Spence DS, Thompson EA, Barron SJ. Homeopathic treatment for chronic disease: a 6-year, university-hospital outpatient observational study. J Altern Complement Med 2005; 11: 793-798. (Full text available at http://www.liebertonline.com/toc/acm/11/5))
I also have to disagree with my learned colleague Mr Hardy. Whilst the results of the Kirsch paper were widely reported SSRIs as being the same efficacy as placebo this was not in fact what the authors reported not what their study showed. In fact SSRIs were consistently more effective than placebo but that this did not reach the arbitrary point for "clinical effectiveness" set by NICE in it's clinical guidelines.
May I take the liberty or recommending www.badscience.net and especially http://www.badscience.net//?p=490 as a starter on the science that may (or may not) lie behind homeopathy? Although 200 years after the therapy was invented we are still awaiting good evidence - and, despite the oft quoted percentages from BMJs Clinical Evidence most interventions actually undertaken do have a sound evidence base.
homeopathic remedies
Hippocratic oath
I rather hope you meant to say: "First do no harm"!
Michael
Editor
PJ Online
Cost of regulating belief-based products is huge
From Dr R. J. Woodward, MRPharmS
So, expensive placebos perceived as analgesics are effective for 85 per cent of patients while cheaper ones are only effective for 61 per cent (PJ, 21 February 2009, p195).
The authorities should take note because the implications of the placebo effect in large swathes of healthcare cannot continue to be ignored by regulators or professionals in orthodox medicine.
Complementary and alternative medicines and therapies are practically all placebos, as intimated in my letter (PJ, 9 August 2008, p160). Acceptance of the existence of two systems of healthcare — evidence-based and belief-based — should not be further delayed.
Most CAM therapies are costly, both in money and time spent with patients by practitioners. I have seen CoQ10 products in health stores at several pounds a capsule, but have never found convincing proof of medical efficacy for the substance. I am convinced that cost is an important factor for the consumer to find benefit.
More importantly, the cost to taxpayers of trying to regulate belief-based products or therapies using evidence-based criteria is huge, and allowing these on the NHS ridiculous. Let us have proper debate on these important matters forthwith because the present situation cannot continue.
In the next few months, it is expected that there will be an outcry from the CAM lobby when the European Commission announces the maximum permitted levels in vitamin and mineral supplements, but this could be an opportunity to look at CAM issues constructively.
Robert Woodward
Retired Pharmacist
Liss, Hampshire
Attempting to gain credence
From Mr P. A. Hardy, MRPharmS
So, the Prince’s Foundation for Integrated Health is looking for interested pharmacists to join its network (PJ, 25 April 2009, p495). It will have more success attracting practitioners if it is less contemptuous of their mainstream role.
A major component of the foundation’s activity is, of course, complementary medicine, but it is frequently uncomplimentary about allopathic medicine. In an item published on the BBC’s news website, its medical director, Michael Dixon, described the process of integrated health: “It means treating patients as whole human beings — paying attention to body, mind and soul — instead of regarding them as nothing more than a set of symptoms to be got out the door as quickly as possible.”
Such a paternalistic view of healthcare practice is insulting and as atavistic as the preferred tastes of the Prince’s Foundation for the Built Environment.
I have no quarrel with the estimable Christine Glover, but the foundation most obviously fails the second of her four “aspects” — that of open-mindedness.
There is no clearer example of a closed mind than one which, faced with a succession of well-conducted trials where, for example, homoeopathy has failed to show benefit, refuses to entertain the notion that these data may be pointing to a genuine truth.
Much has been said in the past about the limitations of randomised clinical trials as a gold standard, but its greatest detractors are those who promote treatments that fail this first hurdle of efficacy.
Paul Hardy
Wakefield, West Yorkshire
Thank you Graham for
Thank you Graham for you correction - extreme compresion led to the false impression given by my previous posting.
P Biswas - to say that science has an incomplete understanding of the body is to state the obvious. The issue at stake here is that greater understanding will not be fostered by abandoning scientific rigour.
Alternative therapies often lie outside conventional scientific understanding of how they should work. That's fine - if they are demonstably effective then science will have to catch up.But until they are shown to deliver when measured objectively, science has no case to answer.
Supply and dispense to rigorous standards and regulations
From Mr B. E. Black, MRPharmS
Recently, I was shown a small, self-sealing plastic bag containing homoeopathic tablets with the product name, the patient’s name, the name of the clinic, and a telephone number.
I questioned the suitability of the container and the labelling (which was hand-written onto the plastic bag) with the clinic. I was informed that this type of packaging was normal and had been passed by its inspectorate. It makes me wonder if the homoeopathic industry is covered by the rules of a regulatory body to ensure compliance with health and safety regulations?
For credibility to be given to homoeopathy and homoeopathic products, clinics must supply and dispense to similar rigorous standards and regulations that are undertaken with conventional medicines. Otherwise, the whole homoeopathic industry could be labelled as irresponsible.
Bernard E. Black
Stanmore, Middlesex
The worried sick
From Mr N. Freedman, MRPharmS
Referring to the Leading article on homoeopathy (PJ, 28 November 2009, p582), I have no concerns about homoeopathy keeping the worried well away from GPs’ consulting rooms, it is the worried sick not seeking conventional treatment that concerns me.
Norman Freedman
Northwood, Middlesex
Empower the general public
From Mr J. D. Thomas, MRPharmS
Most university and scientifically trained primary healthcare professionals would agree with The Journal’s statement (PJ, 28 November 2009, p582) that it does not accept homoeopathic theories, and that they are underpinned by pseudo-science and, also, in my opinion, emotion.
As taxpayers, how can the annual spend of approximately £4m on homoeopathic treatments by the NHS be justified? This expense on homoeopathic products means that £4m is not available for more clinically effective treatments.
Unfortunately, homoeopathy has powerful support in high places and in Parliament. So the profession must tread carefully in this emotive and sensitive matter. The fickle general public will only continue to support those organisations that provide them with what they require and not what the purveyors wish to supply.
This is the crux of how community pharmacy is to deal with homoeopathy, bearing in mind that the Society of Homoeopaths tells its members to avoid making claims implying homoeopathy can cure named diseases.
The profession, especially community pharmacy, must be seen to be pragmatic in the provision of homoeopathic products. In my opinion, they should be as freely available as the wide range of food supplements and vitamins are. They are complementary treatments.
Pharmacists are part of the primary care health team of professionals practising in a retail environment and, as such, my attitude is clear, unambiguous and uncomplicated: should I be presented with a homoeopathic product at an electronic point of sale, I would gladly complete the transaction, well knowing that, even if the whole bottle of tablets were to be ingested, there would no possible overdosage problems.
If, however, I were asked for my professional advice or opinion, I would clearly state that, as a professional with scientific training, I could not explain its efficacy. But with the rider, if it works, so be it.
The present movement is for the general public to be empowered to take control of their health treatments. This must surely include homoeopathic products, as well as the main stream highly promoted over-the-counter products.
J. David Thomas
Patshull, Shropshire