| | (a) The commentator makes the error of claiming there's no proof for Alternative Medicine.
(b) The top hospitals incorporating the alternative therapies make the error of judging a therapy by its popularity -- rather than its objective merit (i.e., they're wasting money).
Here's the proof for these statements:
(a)
... METHODS: We searched for reports of trial results in Ovid Medline, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and proceedings of scientific conferences. We selected reports of randomized, double-blind, placebo-controlled trials of glucosamine for pain from osteoarthritis of the knee or hip. ...
... RESULTS: Fifteen trials met our inclusion criteria. The summary effect size was 0.35 (95% confidence interval 0.14, 0.56). I(2) was 0.80. Except for allocation concealment, no feature of study design explained this substantial heterogeneity. Summary effect sizes ranged from 0.05 to 0.16 in trials without industry involvement, but the range was 0.47-0.55 in trials with industry involvement. The effect size was 0.06 for trials using glucosamine hydrochloride and 0.44 for trials using glucosamine sulfate. Trials using Rottapharm products had an effect size of 0.55, compared with 0.11 for the rest. ...
--Arthritis Rheum. 2007 Jul;56(7):2267-77.
Recap:
Every randomized, double-blind, placebo-controlled trial (every "Gold Standard" trial) of glucosamine showed that it statistically worked (it had a positive effect size; an improvement shown when using a standard deviation as the unit of change). What's funny is how professionals whine about why the results aren't more uniform -- ignoring that they are all positive results (and that there's a roughly-similar variation in outcomes with certain prescription drug trials). Heck, the effects of some approved drugs are all over the place!
Glucosamine Sulfate is one example of an Alternative Medicine that's "proven" by medical science's standards (i.e., by randomized, double-blind, placebo-controlled trials).
(b)
BACKGROUND: Acupuncture and homeopathy are commonly used complementary treatments for chronic asthma. This review summarizes two recently updated Cochrane systematic reviews that assess the safety and efficacy of homeopathy or acupuncture in individuals with chronic stable asthma.
INCLUSION CRITERIA: Only randomized-controlled trials were considered for inclusion. Statistical aggregation of the data was undertaken where possible.
SEARCH STRATEGY: Searches for both reviews were done with the assistance of the Cochrane Airways Group, and through electronic alerts.
RESULTS: ACUPUNCTURE: 11 studies with 324 participants met the inclusion criteria. Trial reporting was poor, and the trial quality was deemed inadequate to generalize the findings. There was variation in the type of active and sham acupunctures, the outcomes assessed and the time points measured. The points used in the sham arm of some studies are used for the treatment of asthma according to traditional Chinese medicine. Two studies used individualized treatment strategies, and one study used a combination strategy of formula acupuncture with the addition of individualized points.
No statistically significant or clinically relevant effects were found for acupuncture compared with sham acupuncture. When data from two small studies were pooled, no difference in lung function was observed (post-treatment FEV1): standardized mean difference 0.12, 95% confidence interval 0.31 to 0.55). ...
... RESULTS: HOMEOPATHY: Six trials with a total of 556 people were included in the review. These trials were all placebo-controlled and double-blind, but were of variable quality. Standardized treatments in these trials are unlikely to represent common homeopathic practice where treatment tends to be individualized. The results of the studies are conflicting in terms of effects on lung function.
There has been only a limited attempt to measure a "package of care" effect (i.e. the effect of the medication as well as the consultation, which is considered a vital part of individualized homeopathic practice). ...
--Respir Med. 2004 Aug;98(8):687-96.
Recap:
Acupuncture and homeopathy aren't good treatments for asthma. The caveat is that this doesn't make both of them totally-useless treatments (acupuncture has helped relieve pain and stress in clinical trials). But these 17 trials -- in the absence of a good explanation for failed results -- ought to be at least enough to close the case on asthma (though I bet some of the "top hospitals" using haven't taken note of this).
The investigators' explanation that a "package of care" is required is not a good one -- as it would violate the placebo control for the studies. They're basically saying that we have to introduce some placebo effects, so that we can "prove" that homeopathy works -- which is simply absurd on its face.
Expert's Note:
This is not an indictment against alternative therapies for asthma, there are other alternative therapies that really do help with asthma.
Ed
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