In fact, CAM research such as homeopathy RCTs represents one of the great challenges and opportunities for EBM to clarify its epistemological stand. It deals with eternal scientific question which comes first : evidence or theory i.e. whether evidence trumps theory or theory comes prior to evidence. In fact, it has been shown that EBM does not have consistent stand on the issue. On one hand, EBM movement has documented numerous examples when getting our evidence right overturned the prevailing theory of the day (e.g. findings from the RCT that tested the effects of hormone-replacement therapy resulted in a dramatic abandonment of theory claiming that estrogen can help reduce risk of coronary disease despite a score of observational studies i.e. lower quality evidence supporting the estrogen theory). However, results of RCT homeopathy trials were largely dismissed not because of lower quality evidence (many of these trials were high-quality placebo-controlled trials) but because of poorly formulated theory which does not correspond to the contemporary physical and chemical principles (homeopathic drugs are prepared by serial dilutions of remedy, the result of which is that "drug" is diluted beyond the point where there is any likelihood that a single molecule from the original solution is present in the final product). In this case, the lack of credible theory trumped seemingly rigorously obtained observations.
ben
Benjamin Djulbegovic, MD, PhD
Professor of Medicine and Oncology
Co-Director of Clinical Translation Science Institute
Director of Center for Evidence-based Medicine and Health Outcomes Research
Mailing Address:
USF Health Clinical Research
12901 Bruce B. Downs Boulevard, MDC02
Tampa, FL 33612
Phone # 813-396-9178
Fax # 813-974-5411
e-mail: [log in to unmask]
______________________
Campus Address: MDC02
Office Address :
13101 Bruce B. Downs Boulevard,
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Tampa, FL 33612
-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Michael Power
Sent: Monday, January 05, 2009 10:43 AM
To: [log in to unmask]
Subject: Re: Fw: Special Issue:Evidence in Evidence-Based Medicine Fw: Social Epistemology - informaworld
<snip>
CAM can't be tested by RCTs because "Randomisation and standardisation are
foreign, and often incommensurate, concepts in CAM"
<snip>
I find it fascinating that The British Homeopathic Association (BHA) does not
agree that CAM can't be tested by RCTs. Their website
(www.trusthomeopathy.org) states "There are over 50 randomised controlled
trials demonstrating homeopathy has a positive effect."
Of course, and this is a key difference between CAM and EBM, it does not say
how well these studies were designed, conducted, and analysed. Nor does it
say how many negative trials there are. If you look in the Cochrane Library
you will find 5 systematic reviews of homeopathy for attention
deficit/hyperactivity disorder, asthma, dementia, nocturnal enuresis, influenza,
and induction of labour. The reviews found 29 RCTs, mostly of poor quality,
and none providing evidence strong enough to support the use of homeopathy.
I expect that, when I read the Social Epistemology articles, I will find the
claim that CAM can't be tested for specific conditions because it treats the
patient holistically. So, it is interesting to see that the BHA has found positive
evidence for the following "conditions" (the scare quotes indicate that this is
the term used by the BHA, but that some "conditions" would not be classified
as such by a medical doctor).
Allergic asthma
Anal fissure
Ankle sprain
Attention deficit hyperactivity disorder
Brain injury
Bronchitis
Cardiac insufficiency
Childhood diarrhoea
Childhood fever
Chronic fatigue syndrome
Common cold
Cough
Dry mouth
Fibromyalgia
Gastrointestinal cramps
Hay fever
Headache
HIV infection
Immune function
Infertility (female)
Influenza
Irritable bowel syndrome
Kidney failure
Low back pain
Migraine
Muscle soreness
Obesity
Osteoarthritis
Otitis media
Plantar fasciitis
Post-operative agitation
Post-operative bruising, pain or swelling
Post-operative ileus
Post-partum bleeding
Post-partum lactation problems
Premenstrual syndrome
Pruritis
Radiotherapy-induced dermatitis
Respiratory tract infection
Seborrhoeic dermatitis
Sepsis
Sinusitis
Stomatitis
Tendinopathy
Tracheal secretions
Varicose veins
Vertigo
Viral infection
A pubmed search found a meta-analysis of trials of homeopathy for
postoperative ileus. The abstract does not say how many trials were found,
but it does say that the primary outcome was time to first flatus.
I think I need a breath of fresh air!
Michael
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