Indwelling needles carry greater risks than acupuncture techniques.
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Acupuncture Therapy↗
Biomedical subjects
E Ernst
Publications and source records attributed to E Ernst.
Acupuncture as a treatment for temporomandibular joint dysfunction: a systematic review of randomized trials.
OBJECTIVE: To summarize the data from randomized controlled trials of acupuncture for temporomandibular joint dysfunction. METHODS: Four independent computerized literature searches were performed. Only randomized trials were admitted in which acupuncture was tested vs sham acupuncture, standard therapy, or no treatment at all. Data were extracted in a predefined, standardized fashion. RESULTS: Six reports met the inclusion and exclusion criteria, representing 3 distinct trials. Overall, their results suggest that acupuncture might be an effective therapy for temporomandibular joint dysfunction. However, none of the studies was designed to control for a placebo effect. CONCLUSION: Even though all studies are in accordance with the notion that acupuncture is effective for temporomandibular joint dysfunction, this hypothesis requires confirmation through more rigorous investigations.
Acupuncture Therapy↗
The efficacy of ginseng. A systematic review of randomised clinical trials.
OBJECTIVE: Ginseng is one of the most popular herbal remedies, and a number of health claims are made for it. This systematic review provides an evaluation of the current evidence for or against the efficacy of ginseng root extract. METHODS: Searches of the computerised literature databases Medline, Embase, Biosis, CISCOM and the Cochrane Library were performed to retrieve double-blind, randomised, placebo-controlled trials of ginseng root extract for any indication. Manufacturers and experts were contacted to provide additional information. There were no restrictions regarding the language of publication. The outcome and methodological quality of all trials were independently assessed by two reviewers. RESULTS: Sixteen trials met the inclusion criteria and were reviewed. These trials related to physical performance, psychomotor performance and cognitive function, immunomodulation, diabetes mellitus and herpes simplex type-II infections. The evidence found for ginseng root extract is compelling for none of these indications. CONCLUSION: Based on these data, it is concluded that the efficacy of ginseng root extract is not established beyond reasonable doubt for any of these indications. The widespread use of ginseng as a herbal remedy warrants more rigorous investigations to assess its efficacy and safety.
Adjuvants, Immunologic↗
Prevalence of complementary/alternative medicine for children: a systematic review.
UNLABELLED: Complementary/alternative medicine (CAM) has become an important topic, not least because of its popularity with patients. This systematic review is aimed at summarising the data known about CAM use in paediatric populations. A thorough search strategy was designed to identify all surveys on the prevalence of CAM utilisation in children. Data from those investigations that met the pre-defined criteria for inclusion were extracted and reported in a standardised fashion. Ten studies were found. Their results suggest that the prevalence of CAM use is variable but generally high. CAM is often perceived as helpful. Insufficient data exist about safety and cost. CONCLUSION: The generally high and possibly growing prevalence of complementary/alternative medicine use by children renders this topic an important candidate for rigorous investigation. In particular, we should determine the efficacy, safety and expense of these treatments through rigorous, unbiased investigations.
Child↗
Menstrual cycle pattern and fertility: a prospective follow-up study of pregnancy and early embryonal loss in 295 couples who were planning their first pregnancy.
OBJECTIVE: To characterize how the menstrual cycle pattern relates to fertility regardless of potential biases caused by inappropriate coital timing during the menstrual cycle or early embryonal loss. DESIGN: Prospective follow-up study. SETTING: Healthy couples recruited throughout Denmark. PATIENT(S): Two hundred ninety-five couples who were planning their first pregnancy were followed up from the discontinuation of birth control until a pregnancy was recognized within six menstrual cycles. Early embryonal losses were detected by changes in urinary hCG levels. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The probability of pregnancy occurring within one menstrual cycle (fecundity). RESULT(S): In women who had a cycle length that differed by >10 days from the usual cycle length, fecundity was approximately 25% that of women who had no variation (odds ratio 0.25, 95% confidence interval 0.09-0.68). When the combined effect of cycle variation and cycle length was assessed, cycle variation was a persistent strong predictor of fecundity. CONCLUSION(S): The mechanisms of the present findings probably are female functional disturbances in ovulation, conception, implantation, or sustained pregnancy, linked with variable menstrual cycle length. Thus, identification of medical and environmental causes of abnormal menstrual cycle patterns may provide clues to the causes of infertility. Moreover, the menstrual cycle pattern also should be taken into consideration in the clinical decision-making process.
Abortion, Spontaneous↗
Distress and reduced fertility: a follow-up study of first-pregnancy planners.
OBJECTIVE: To assess the effect of psychological distress on time to first pregnancy. DESIGN: A follow-up study of time to pregnancy with prospective data on distress, with controlling for potential confounding variables. SETTING: Two university hospitals. PATIENT(S): Danish couples (n = 430) who were planning their first pregnancy and had no previous reproductive experience were followed for six menstrual cycles. Psychological distress was measured in each menstrual cycle by the General Health Questionnaire. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): A clinically recognized pregnancy or a biochemical pregnancy detected in urine samples from each period of vaginal bleeding. RESULT(S): For cycles with the highest distress score (General Health Questionnaire score >80th percentile), the probability of conception per cycle was 12.8%, compared with 16.5% in other cycles (adjusted odds ratio [OR] 0.6; 95% confidence interval [CI] 0.4-1.0). The effect of distress was found almost exclusively among women with long menstrual cycles (OR 0.1; 95% CI 0.01-0.4 and OR 0.9; 95% CI 0.5-1.4 for women with cycles of > or =35 and <35 days, respectively). An increased incidence of early embryonal loss was also found among highly distressed women with long cycles, but was based on a small number of observations. CONCLUSION(S): Psychological distress may be a risk factor for reduced fertility in women with long menstrual cycles.
Abortion, Spontaneous↗
Experts' opinions on complementary/alternative therapies for low back pain.
BACKGROUND: Complementary/alternative therapies are used for low back pain more frequently than for any other indication, yet evidence for or against their efficacy is fragmentary. Notwithstanding this void, the high prevalence of such therapies drives their integration into our health care systems. Expert opinions on the use of complementary/alternative therapies for low back pain could therefore be helpful until more data from randomized, controlled trials become available. OBJECTIVE: A postal questionnaire survey was designed to generate opinion from a systematically identified expert panel on the clinical effectiveness of complementary/alternative therapies for low back pain. METHODS: Computerized searches were conducted to systematically identify by objective criteria 50 clinical experts on low back pain. Each panel member received a questionnaire to assess the perceived clinical effectiveness of complementary/alternative therapies for 4 defined categories of low back pain. RESULTS: For acute uncomplicated low back pain, osteopathy and chiropractic were rated as effective by most experts. For chronic uncomplicated low back pain, most experts considered acupuncture as effective. Experts perceived homeopathy generally as ineffective for any type of low back pain. Clinical experience with herbalism as a treatment for low back pain was insufficient to form an opinion. CONCLUSION: Experts' opinion is in favor of the effectiveness of osteopathy and chiropractic for acute uncomplicated low back pain. Acupuncture is judged to be of some value for chronic, uncomplicated low back pain. Homeopathy is perceived as ineffective for any type of low back pain. Insufficient experience with herbalism as a treatment for low back pain prevents firm conclusions.
Acute Disease↗
Massage therapy for low back pain: a systematic review.
Massage therapy is frequently employed for low back pain (LBP). The aim of this systematic review was to find the evidence for or against its efficacy in this indication. Four randomized clinical trials were located in which massage was tested as a monotherapy for LBP. All were burdened with major methodological flaws. One of these studies suggests that massage is superior to no treatment. Two trials imply that it is equally effective as spinal manipulation or transcutaneous electrical stimulation (TES). One study suggests that it is less effective than spinal manipulation. It is concluded that too few trials of massage therapy exist for a reliable evaluation of its efficacy. Massage seems to have some potential as a therapy for LBP. More investigations of this subject are urgently needed.
Humans↗
Homeopathic prophylaxis of headaches and migraine? A systematic review.
Homeopathy is often advocated as a prophylaxis of migraine and headaches. The aim of this systematic review was to evaluate the clinical trials, testing the efficacy of homeopathy for these indications. Independent computerized literature searches were carried out in 4 databases. Only randomized, placebo-controlled trials were included. Four such studies were found. Their methodological quality was variable but, on average, satisfactory. One study suggested that homeopathic remedies were effective. The other, methodologically stronger trials did not support this notion. It is concluded that the trial data available to date do not suggest that homeopathy is effective in the prophylaxis of migraine or headache beyond a placebo effect.
Humans↗
Hypericum for depression. An update of the clinical evidence.
This review is aimed at providing an updated evaluation of the clinical evidence regarding Hypericum perforatum (St. John's wort) as an antidepressant, based on recently published randomised controlled trials. Computerised literature searches revealed six trials published since the metaanalysis by Linde et al. (1996) [Linde, K., Ramirez, G., Mulrow, C.D., Pauls, A., Weidenhammer, W., Melchart, D., 1996. St. John's wort for depression--an overview and meta-analysis of randomised clinical trials. Br. Med. J. 313, 253-258]. The results of these studies provide further evidence that hypericum is superior to placebo in treating mild or moderate depression. However, there is still insufficient evidence to assess the efficacy of hypericum in comparison with conventional, particularly modern, antidepressants. Furthermore, there remains a lack of trials assessing long-term effects, other types of depression and different preparations and doses. It is concluded that recent clinical trials strengthen the case for hypericum as an antidepressant, but more work needs to be done to answer the remaining questions.
Amitriptyline↗
How useful are unconventional cancer treatments?
Unconventional cancer treatments are used frequently. Therefore, oncologists need to know about them. This article gives an overview of current knowledge on the most prevalent complementary or alternative cancer therapies. A distinction is made between alleged cures, preventive and adjunctive measures. Shark cartilage, mistletoe, thymus therapy, essiac, hydrazine sulphate, 714-X, dietary regimens, green tea and Panax ginseng are all covered specifically. None of these treatments offer reasonable hope for a cure. Some strategies are promising in terms of cancer prevention. The true potential of unconventional therapies might lie in adjunctive and palliative care. It is concluded that good evidence in this area is scarce. Vis-à-vis the high prevalence of unconventional cancer treatments, rigorous investigations are mandatory, not least for increasing the safety of future patients.
Complementary Therapies↗
Funding research into complementary medicine: the situation in Britain.
This article outlines the theoretical options for research funding for complementary medicine in Britain. Sponsorship from the National Health Service, the Medical Research Council, Medical Research Charities, the industry and private donations constitute the main potential sources. Surveys of the actual funding spent by these sources are evaluated. The data thus generated suggest that funds for research into complementary medicine are not readily available in the UK. Several suggestions are made to ameliorate this situation and the case for 'ring-fenced' funding is put forward, not least on the basis of international experience.
Complementary Therapies↗
Reviewer bias against the unconventional? A randomized double-blind study of peer review.
OBJECTIVE: To test the hypothesis that there is a reviewer bias against publication of a test of an unconventional drug. DESIGN: Randomized, controlled, double-blind study of peer review. PARTICIPANTS: Convenience sample of 291 medical doctors from a wide variety of specialties drawn from a list of conference participants. METHODS: Reviewers were randomly assigned to receive one of two versions of a manuscript. Version M related to an in-vitro experiment on a mainstream drug (Metoprolol). The otherwise identical version V used a highly unconventional drug (beef spleen cell extract) for the same experiment. Reviewers were asked to complete a standardised evaluation sheet including visual analogue scales (VASs) on a set of predefined quality criteria. All participants were debriefed after completion of the study. RESULTS: The response rate was 61%. There were no significant differences in VAS ratings between the two versions of the manuscript. Ratings covered the entire range of the VASs. CONCLUSION: In the present setting, there was no evidence for a reviewer-bias against testing an unconventional drug. The low inter-rater reliability, however, suggested inadequate validity of peer review.
Animals↗
From medical herbalism to phytomedicine: back to the future?
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Evidence-Based Medicine↗
Randomized, double-blind trial of chitosan for body weight reduction.
BACKGROUND: Overweight and obesity is a prevalent and costly threat to public health. Compelling evidence links overweight and obesity with serious disorders such as cardiovascular diseases and diabetes. Dietary regimen are notoriously burdened with poor compliance. Chitosan is promoted in the US and other countries as an oral remedy to reduce fat absorption and has now been incorporated as a major constituent into several over-the-counter remedies. The primary aim of this study is to investigate the clinical effectiveness of oral chitosan for body weight reduction. METHODS: Thirty-four overweight volunteers were included in a randomized placebo-controlled double-blind trial. Subjects were assigned to receive either four capsules of chitosan or indistinguishable placebo twice daily for 28 consecutive days. Measurements were taken at baseline, after 14 and 28d of treatment. Subjects maintained their normal diet and documented the type and amount of food consumed. Adverse effects were assessed and compliance monitored. RESULTS: Data from 30 subjects were entered into an intention-to-treat analysis. After four weeks of treatment, body mass index, serum cholesterol, triglycerides, vitamin A, D, E and beta-carotene were not significantly different in subjects receiving chitosan compared to those receiving placebo. Vitamin K was significantly increased after four weeks in the chitosan group compared with placebo (P<0.05). Compliance was 91.5% and 96.0% for chitosan and placebo groups respectively. CONCLUSION: The above data suggest that chitosan in the administered dosage, without dietary alterations, does not reduce body weight in overweight subjects. No serious adverse effects were reported.
Adolescent↗
The treatment of eczema with Chinese herbs: a systematic review of randomized clinical trials.
AIMS: Chinese herbal treatments are being promoted as a treatment for eczema. The aim of this study was to systematically review the evidence for or against this notion. METHODS: Extensive literature searches were carried out to identify all randomised clinical trials on the subject. Data were extracted from these in a predefined standardized fashion. RESULTS: Only two randomized clinical trials were located. Both imply that a complex mixture of Chinese herbs is more effective than placebo in treating eczema. Yet several caveats exist, most importantly the lack of independent replication. Adverse effects have also been reported. CONCLUSIONS: At present it is unclear whether Chinese herbal treatments of eczema do more good than harm.
Adult↗
Ginkgo biloba for tinnitus: a review.
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Antioxidants↗
Artemether for severe malaria: a meta-analysis of randomized clinical trials.
The treatment of choice for severe malaria is quinine. However, a gradual progression of resistance to quinine has become a concern in parts of the world. Artemisinin-related compounds are a relatively new class of drugs. This meta-analysis assesses the evidence regarding the clinical effectiveness of artemether for severe malaria. Computerized literature searches identified all randomized clinical trials of artemether in comparison with quinine. Standardized data extraction was independently performed by both authors. Results of nine trials, entered in the meta-analysis, demonstrate the absence of a significant difference between artemether and quinine in terms of mortality rate (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.50-1.14). Statistical pooling of data from trials in Southeast Asia showed a trend toward enhanced reduction of mortality (OR, 0.38; 95% CI, 0.14-1.02). These data demonstrate the equality of artemether and quinine for severe malaria and indicate a trend toward greater effectiveness of artemether in regions where there is recognized quinine resistance.
Antimalarials↗