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Volume 106 Number 2
AJHM Summer 2013 81
Research Update
had more moderate expectations. The authors concluded
that placebo research in laboratory analogue studies does
not generalize to clinical practice. Clients improve in
outcome because they gain intrinsic satisfaction from the
therapeutic ritual, not because they expect to get better.
The CAMBRELLA group presented ‘A systematic
literature review of Complementary and Alternative
Medicine (CAM) prevalence in EU.’ They systematically
reviewed the published data reporting research quality and
the prevalence of citizens CAM use in Europe; what it is
used for, and why. Eighty-seven studies were included.
Study methodology and quality of reporting were poor and
for the majority of EU countries no data was available. The
prevalence of CAM use varied widely within and across
EU countries (0.3% to 86%). Herbal medicine was most
commonly reported with prevalence rates varied from 5.9–
48.3%; Homeopathy was used by 2–27%, Chiropractic by
0.4–20.8%, Acupuncture by 0.44–23% and reflexology
by 0.4–21% of people studied. CAM users were mainly
women. Common reasons for use were dissatisfactions
with conventional care; CAM was widely used for
musculoskeletal problems.
The same group reported on ‘Complementary and
Alternative Medicine Provision in Europe – First Results,’
with an aim to describe the CAM services available from
both, registered medical practitioners and registered non-
medical practitioners. Due to the differing reliability of data
sources, a classification was developed and implemented.
This weighted database was condensed into tables and maps
to display the provision of CAM provision of disciplines by
country, showing the distribution of CAM providers across
countries. Results: approximately 305,000 registered
CAM providers can be identified in the EU (~160,000
non-medical and ~145,000 medical practitioners).
Acupuncture (n = 96,380) is the most available therapeutic
method for both medical (80,000) and non-medical
(16,380) practitioners, followed by homeopathy (45,000
medical and 5,800 nonmedical practitioners). Herbal
medicine (29,000 practitioners) and reflexology (24,600
practitioners) are mainly provided by non-medical
practitioners. Naturopathy (22,300) is dominated by
15,000 (mostly German) doctors. Anthroposophic
medicine (4,500) and neural therapy (1,500) are practiced
mainly by doctors. With a huge variability in its national
regulatory management, direct comparison across the
EU is almost impossible. Harmonization of legal status,
teaching and certification of expertise for therapists would
be of enormous value and should be developed.
‘Feasibility and Design of an Open Label Pilot
Study of Homeopathic Treatment of Attention Deficit
Hyperactivity Disorder,’ was presented by researchers
from Canada led by David Brulé. An open-label pilot
study of individualized homeopathy for attention deficit
hyperactivity disorder (ADHD) was conducted in order to
assess potential for a future, more scientifically rigorous
study. Three key objectives were: 1. To develop estimates
of treatment effects; 2. To determine the time, number of
consultations and the number of different homeopathic
remedies needed for a statistically significant improvement
in ADHD symptoms; and 3. To assess recruitment plan
and outcome measure feasibility. Participants with ADHD
aged 6-16 years completed ten individualized homeopathic
consultations and underwent a diagnostic assessment by
the study psychologist. Effects on ADHD symptoms were
assessed using the Conners 3—Parent questionnaire and
self-report symptoms using the MYMOP2. Data were
analyzed with SPSS statistical software. The clinically
significant change in the pre- and post-study difference in
Conners Global Index (CGI-P) T-score was defined using
the Conners Reliable Change Index (≥7.36). Thirty-six
participants were enrolled over 11 months. Eighty percent
(28/35) completed all ten consultations in a median of 11.8
months (range 10.0–16.5). Of these, 22/35 (63%) had a
clinically significant improvement in the primary outcome
(CGI-P T-score), first occurring after a mean of 4.2 visits
(range 2–10) and after trying on average 1.6 remedies (range
1–4). Overall CGI-P T-scores for participants completing
at least two data points decreased from a baseline mean of
82.14 to 72.26 at the end of the participant enrolment in
the study (p<0.001). No serious adverse events related to
the therapy were reported. 82% of the Conners 3 - Parent
questionnaires were completed. MYMOP2 was deemed
not feasible due to poor compliance.
Peter
Fisher
presented
‘Polypharmacy
and
multimorbidity: implications for integrative medicine
research.’With co-authors Jennifer Jacobs and JohnHughes,
they surveyed the medical literature on polypharmacy (the
use of five or more conventional drugs at one time) and
its association with multimorbidity, and they searched
for evidence on integrative approaches for conditions
commonly associated with polypharmacy. Results:
polypharmacy affects 40% of US seniors with a rising
trend, the situation in Europe is similar. In 1998 adverse
drug reactions (ADRs) were the fifth most common cause
of death in the US. There are also more insidious effects
including cognitive, balance and continence problems with
multiplemedications. The probability of seriousADRs rises
sharply with the number of drugs taken. Several integrative
medicine (IM) approaches have potential for reducing
drug requirements in conditions commonly resulting in
polypharmacy including acupuncture for chronic pain,
which could reduce use of analgesics, and homeopathy to
reduce antibiotics for upper respiratory tract infection in
children. Current evidence suggests that pain, anxiety and
depression, and antibiotic overuse are significant problems.
These should be systematically mapped against findings,
which suggest that integrative methods may be effective.
Areas where polypharmacy is a problem and IM appears
effective should be prioritized for research. See their
related full article for more details. (Jennifer Jacobs, Peter
Fisher. ‘Polypharmacy, multimorbidity and the value of
integrative medicine in public health,’ European Journal of