Research Database -
International Updates

Alternative Medicine/
Complementary Therapies

Issue 63

EASTWOOD, Department of Social and Preventive Medicine, University of Queensland, Brisbane, Australia, h.eastwood@spmed.uq.edu.au reviewed (23 references) reasons for the apparent increasing provision or support of complementary and alternative medicine (CAM) by general practitioners (GPs).
Discussion: ‘Globalisation’ and ‘postmodernization’ are creating rapid and pervasive social change, a prominent characteristic of which is greater choice, both for patients and GPs. GPs are both responding to increased demand for CAM from patients and acknowledging the limitations of orthodox biomedical treatments by promoting CAM as part of their service delivery despite lack of scientific validation of CAM. ‘Clinical legitimacy’ is overriding ‘scientific legitimacy’ as GPs as move towards healing and the ‘art’ as opposed to the ‘science’ of medicine.
Eastwood HL. Complementary therapies: the appeal to general practitioners. The Medical Journal of Australia 173 (2): 95-8. Jul 2000.

CURDA and colleagues, Krankenanstalt Gasteiner Heilstollen, Bad Gastein-Bockstein, Austria investigated the frequency of use of unconventional therapies by patients with ankylosing spondylitis presenting for treatment at a radon spa.
Background: A large proportion of rheumatism patients treated by rheumatologists also use unconventional therapies.
Methods: 75 patients with ankylosing spondylitis presenting for treatment at the Gasteiner Heilstollen Hospital were asked to name all interventions they had used for the treatment of the condition in question.
Results: 39 of the 75 patients (52%) had used other unconventional therapies. The most frequently cited were: acupuncture (cited 15 times), diet (8), herbal therapy (7) and homeopathy (6). 40 different forms of unconventional therapy were mentioned. All patients (100%) said they had used at least two conventional therapies.
Conclusion: Patients with ankylosing spondylitis presenting for treatment at a radon spa claimed to have used conventional therapies more frequently than unconventional therapies.
Curda B et al. Use of conventional and unconventional therapies among patients with ankylosing spondylitis. Forschende Komplementaermedizin und Klassische Naturheilkunde 7 (2): 85-88. Apr 2000.

ZIMPEL and WINDELER, Abteilung Medizinische Biometrie, Universitatsklinikum Heidelberg, Heidelberg, Germany investigated whether a publication bias could be shown for the results of medical theses on all kinds of complementary therapies and what factors influencing publication could be identified.
Background: The problem of ‘publication bias’ has been highlighted in recent years as a threat to the validity of meta-analyses and systematic literature reviews. Successful strategies for dealing with this problem have yet to be established.
Methods: 140 medical theses for the years 1982-1992 on all kinds of complementary therapies were identified and all were included in the study. Data from the theses were analysed. Publications arising from the theses were searched for on MEDLINE and by personal communication with the authors and authors’ supervisors. Factors that might influence the likelihood of publication were identified by bivariate analysis and logistic regression analysis.
Results: Publications were found for 53 (37.9%) of the 140 medical theses examined. The main factors influencing the likelihood of publication were: ‘positive result’ (odds ratio 2.337); ‘high-level statistical analysis’ (odds ratio 1.483); ‘supervisors with a high publication output’ (odds ratio 1.477); and ‘candidates of younger age’ (odds ratio 0.691).
Conclusion: As has been found for other medical subjects, there was an apparent publication bias for complementary medicine, with positive results having a greater chance of publication than negative ones.
Zimpel T and Windeler J. (Publications of dissertations on unconventional medical therapy and diagnosis procedures – a contribution to ‘publication bias’.) Forschende Komplementaermedizin und Klassische Naturheilkunde 7 (2): 71-4. Apr 2000.

POKANEVYCH and colleagues, (No information re. affiliation/institution) investigated the effects of multimodal treatment including homeopathy on facial nerve neuropathy.
Methods: 103 patients with facial nerve neuropathy were treated with infra-red laser puncture (wave length 890 nm, average power 15 mW/cm2) and homeopathy.
Results: All 103 patients apparently benefited from treatment. Treatment benefits were confirmed by electrophysiological measurements and acupuncture diagnostic techniques.
Pokanevych VV et al. (The combination of reflexotherapy and homeopathy in treating patients with facial nerve neuropathy.) Likars’ka Sprava 2: 115-9. Mar 2000.

Issue 62

COOKE and ERNST, Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, UK, conducted a systematic review (28 references) of aromatherapy.
Background: In this study the authors stated that Aromatherapy is becoming increasingly popular despite the fact there are few clear indications for its use. The authors reviewed the literature on aromatherapy in order to discover whether any clinical indication may be recommended for its use.
Methods: Computerised literature searches were performed to retrieve all randomised controlled trials of aromatherapy from the following databases: MEDLINE, EMBASE, British Nursing Index, CISCOM, and AMED. The methodological quality of the trials was assessed using the Jadad score. Trials were independently evaluated and data were extracted in a pre-defined, standardised fashion.
Results: Twelve trials were located: six of them had no independent replication; six related to the relaxing effects of aromatherapy combined with massage. These studies suggest that aromatherapy massage has a mild, transient anxiolytic effect.
Conclusions: The authors concluded that based on a critical assessment of the six studies relating to relaxation, the effects of aromatherapy are probably not strong enough for it to be considered for the treatment of anxiety. The hypothesis that it is effective for any other indication is not supported by the findings of rigorous clinical trials.
Cooke B and Ernst E. Aromatherapy: a systematic review. British Journal of General Practice 50(455): 493-6. Jun 2000.

Comments: Readers should be aware that the authors’ conclusions (that the evidence is not strong enough to support massage being considered for the treatment of anxiety) were based only upon the very few randomized controlled studies (6) in which the data were standardized, and do not in any way reflect the considerably larger clinical body of literature belonging to aromatherapy. This is a problem as I see it in today’s somewhat obsessive attention only to research of a certain design, i.e., randomized controlled trials. It is, in my opinion, simply not valid to disregard all other clinical research and draw conclusions based on a very few published trials.

Murugesan, Govindarajulu and Bera, Department of Physical Education, Pondicherry University, India, examined the effect of selected yogic practices on the management of hypertension.
Methods: On the basis of a medical officer’s diagnosis, thirty three hypertensives, aged 35-65 years, from Govt. General Hospital, Pondicherry, were examined for systolic and diastolic blood pressure, pulse rate and body weight. The subjects were randomly assigned into three groups. Group-I underwent selected yoga practices, group-II received medical treatment by the physician of the hospital and the control group did not participate in any treatment stimuli. Yoga was performed in the morning and in the evening with 1 hr/session per day for a total period of 11 weeks. Medical treatment consisted of the usual medication every day for the whole experimental period.
Conclusion: Pre-post test with ANOVA revealed that both the treatment stimuli (i.e., yoga and drug) were effective in controlling the variables of hypertension.
Murugesan R et al. Effect of selected yogic practices on the management of hypertension. Indian Journal of Physiology and Pharmacology 44(2): 207-10. Apr 2000.

Issue 61

DE VISSER, EZZY and BARTOS, Australian Research Centre in Sex, Health, and Society, La Trobe University, Melbourne, Australia studied alternative and complementary therapy use among people with HIV/AIDS.
Background: Many people with HIV/AIDS use alternative therapies. Do they choose alternative therapies instead of allopathic therapies?
Methods: The authors examined patterns of use of allopathic therapies and alternative therapies among people living with HIV/AIDS. A cross-sectional survey of 925 men and women living with HIV/AIDS in Australia was performed. Correlates of choice of therapy included demographic variables, sources of information about treatment, and attitudes toward treatments and health management. Results: 56% of people living with HIV/AIDS in Australia use alternative therapies. Attitudes toward both allopathic and alternative therapies were positive. The choice of allopathic and/or alternative therapies was related to disease progression. Choice of therapy was also related to attitudes toward allopathic and alternative therapies. Many users of alternative therapies believe that such therapies can alleviate the side effects of antiretroviral drugs.
Conclusions: The results of this study suggest that rather than being used as an alternative to allopathic medicine, non-allopathic therapies are used by people living with HIV/AIDS as complementary therapies.
De Visser R et al. Alternative or complementary? Non-allopathic therapies for HIV/AIDS. Alternative Therapies in Health and Medicine 6 (5): 44-52. Sep 2000.

EVRARD BRAS and colleagues, Service de Medecine B et Angiologie Hopital Saint-Eloi, Montpellier, France reviewed the effectiveness of manual physiotherapy (lymphatic drainage) for the treatment of chronic circulatory stasis of the lower limbs.
Background: Manual lymphatic drainage for chronic venous and lymphatic stasis of the lower limbs consists of manipulations of the limb to aid movement of lymph and its resorption into lymphatic vessels and ultimately the venous circulation.
Discussion: The technique is not particularly effective on its own – it is necessary to combine it with other techniques such as defibrosing, skin care, compressive bandages and muscular exercise, all of which help to prolong the action of lymphatic drainage.
Conclusions: Manual lymphatic drainage is the best treatment, when combined with other supporting techniques, for chronic venous and lymphatic stasis of the lower limbs. Its main use is in primary and secondary lymphoedema, but it is also useful in chronic venous disease, and in certain cases of acute venous thrombosis and traumatic or post-traumatic pain.
Evrard Bras M et al. Drainage lymphatique manuel (Manual lymphatic drainage). La Revue du Practicien 50 (11): 1199-203. Jun 2000.

VAN HASELEN and FISHER, The Royal London Homoeopathic Hospital, Great Ormond Street, London WC1N 3HR, UK compared the efficacy and safety of a homeopathic gel with those of a non-steroidal anti-inflammatory (NSAID) gel (piroxicam) in treating osteoarthritis of the knee.
Methods: This randomized, double-blind, controlled trial included 184 out-patients with radiographically confirmed symptomatic osteoarthritis of the knee. Patients were treated with 1 g of gel (either homeopathic or NSAID) three times daily for 4 weeks. Pain on walking was assessed on a visual analog scale (VAS). A further measure used was a single-joint Ritchie index.
Results: The pain score on the VAS was reduced by 16.5 mm in the homeopathic gel-treated group and by 8.4 mm in the NSAID-treated group; after adjustment for pain at baseline (before treatment), the difference in VAS scores between the two treatment groups was 6.8 mm (95% confidence interval –0.3 to 13.8). There was no significant difference in the single-joint Ritchie index between the two groups. Adverse events (side effects) occurred in 12 patients in the homeopathy group and 16 patients in the NSAID group; 5 patients in the homeopathy group and 9 in the NSAID group withdrew from the trial. In the homeopathy group, 7 of the adverse events involved a local reaction (2 such patients withdrew); in the NSAID group, 11 of the adverse events involved a local reaction (5 such patients withdrew).
Conclusions: The homeopathic gel was at least as effective and as well tolerated as the NSAID (piroxicam) gel. It is possible there was a clinically relevant difference between the two treatment groups. The homeopathic gel, supplemented by simple analgesics if required, may be a useful treatment option for patients with osteoarthritis.
Van Haselen RA and Fisher PA. A randomized controlled trial comparing topical piroxicam gel with a homeopathic gel in osteoarthritis of the knee. Rheumatology 39 (7): 714-9. Jul 2000.

FIELD and colleagues, Touch Research Institute, University of Miami School of Medicine, Miami, Florida 33101, USA assessed the effectiveness of massage therapy for the treatment of burn injuries in comparison with standard treatment.
Methods: 20 patients with burn injuries received either massage therapy or standard treatment during the remodeling phase of wound healing. Massage therapy consisted of a 30-minute massage with cocoa butter to a closed, moderate-sized area of scar tissue twice a week for 5 weeks.
Results: Patients who received massage therapy reported reduced itching, pain, and anxiety, and improved mood immediately after the first and last therapy sessions. Their ratings on these measures improved from the first day to the last day of the study.
Conclusions: Massage therapy of closed scar tissue in the remodeling phase of wound healing following a burn injury helps reduce itching and pain and improve mental wellbeing in the period immediately after therapy, and these effects continue to be experienced over at least 5 weeks of therapy.
Field T et al. Postburn itching, pain, and psychological symptoms are reduced by massage therapy. Journal of Burn Care & Rehabilitation 21 (3): 189-93. May-Jun 2000.
Comments: The above research studies demonstrate that therapies such as massage, homeopathy and acupuncture are effective in the relief of pain for a variety of conditions, including burns and osteoarthritis.

Issue 60

IRELAND and OLSON, College of Nursing, Rutgers, State University of New Jersey, Newark, USA reviewed the effect of massage therapy and therapeutic touch in children.
Methods: Studies were obtained through computer searches of CINAHL, MEDLINE, PsychInfo, and SocioFile. Key words used were tactile, kinaesthetic, massage therapy, touch, therapeutic touch, infants, and children. Fourteen massage therapy studies were selected because they met the following 3 criteria: investigated massage therapy in children; were published in refereed nursing, allied health, or infant and child development journals between 1969 and 1999; and were quantitative in nature. Studies were divided according to developmental age for analysis: neonates, preschool, and older children. Five therapeutic touch studies, 3 quantitative and 2 qualitative, were selected because they were the only empirical reports about the effect of therapeutic touch in children to date. In addition to critiques, the therapeutic touch studies were examined for the following 10 characteristics: study purpose/hypotheses, background/literature review, sample selection method, study design/random assignment, independent variable/length of treatment/ control and confounders, dependent variables/measurements, outcomes, study limitations, and implications for future research.
Results: More research exists to support the use of massage therapy than therapeutic touch in children. A set of common findings across 2 decades of study suggests that massage therapy may be useful in the care of infants and children.
Conclusion: Because massage therapy and therapeutic touch seem to elicit similar parasympathetic effects, therapeutic touch may be useful. There is insufficient evidence, however, to recommend its use in children without qualifications.
Ireland M and Olson M. Massage therapy and therapeutic touch in children: state of the science. Alternative Therapies in Health and Medicine 6 (5): 54-63. Sep 2000.

TAYLOR and colleagues, University Department of Medicine, Glasgow Royal Infirmary, Glasgow, conducted a randomized controlled trial of homeopathy versus placebo in perennial allergic rhinitis.
Background: The authors set out to test the hypothesis that homeopathy is a placebo by examining its effect in patients with allergic rhinitis and so contest the evidence from three previous trials in this series.
Methods: Randomized, double blind, placebo- controlled, parallel group, multicentre study. Fifty-one patients with perennial allergic rhinitis from four general practices and a hospital ear, nose, and throat outpatient department participated. Patients were randomly assigned to an oral 30c homoeopathic preparation of principal inhalant allergen or to placebo. Changes from baseline in nasal inspiratory peak flow and symptom visual analogue scale score over third and fourth weeks after randomization.
Results: Fifty patients completed the study. The homeopathy group had a significant objective improvement in nasal airflow compared with the placebo group (mean difference 19.8 l/min). Both groups reported improvement in symptoms, with patients taking homeopathy reporting more improvement in all but one of the centres, which had more patients with aggravations. On average no significant difference between the groups was seen on visual analogue scale scores. Initial aggravations of rhinitis symptoms were more common with homeopathy than placebo (7 (30%) v 2 (7%)). Addition of these results to those of three previous trials (n=253) showed a mean symptom reduction on visual analogue scores of 28% (10.9 mm) for homeopathy compared with 3% (1.1 mm) for placebo.
Conclusions: The objective results reinforce earlier evidence that homeopathic dilutions differ from placebo.
Taylor MA et al. Randomised controlled trial of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series. British Medical Journal 321 (7259): 471-6. Aug 2000.

CUCHERAT and colleagues, Department of Clinical Pharmacology, Hospitals of Lyon and University Claude Bernard, France. mcu@upcl.univ-lyonl.fr reviewed evidence of clinical efficiency of homeopathy from a meta-analysis of clinical trials.
Methods: Published and unpublished reports of controlled clinical trials available up to June 1998, identified by searching bibliographic databases (Medline, Embase, Biosis, PsychInfo, Cinahl, British Library Stock Alert Service, SIGLE, Amed), references lists of selected papers, hand searching homeopathic journals and conference abstracts, and contacting pharmaceutical companies. Trials were selected using an unblinded process by two reviewers. The selection criteria were randomized, controlled trials in which the efficacy of homeopathic treatment was assessed relative to placebo in patients using clinical or surrogate endpoints. Prevention trials or those evaluating only biological effects were excluded. One hundred and eighteen randomized trials were identified and evaluated for inclusion. Sixteen trials, representing 17 comparisons and including a total of 2,617 evaluated patients, fulfilled the inclusion criteria.: Data were extracted by two reviewers independently, using a summary form. Disagreements were resolved by a third person.
Results: Initial analysis of the 17 comparisons suggested a significant effect for the use of homeopathy. However, as trials were excluded in a stepwise manner based on their level of quality, homeopathic treatments were shown to have insignificant effects.
Conclusions: There is some evidence that homeopathic treatments are more effective than placebo; however, the strength of this evidence is low because of the low methodological quality of the trials. Studies of high methodological quality were more likely to be negative than the lower quality studies. Further high quality studies are needed to confirm these results.
Cucherat et al. Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeopathic Medicines Research Advisory Group. European Journal of Clinical Pharmacology 56 (1): 27-33. Apr 2000.

White and Ernst, Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, Exeter, UK. a.r.white@ex.ac.uk systematically reviewed economic analysis of complementary medicine.
Methods: Searches were performed in Medline, Embase and AMED for reports of cost description, cost comparison, cost effectiveness, or cost benefit studies. Prospective studies that investigated comparative groups were considered to be of higher quality.
Results: A total of 34 reports were included. Retrospective studies in which a range of therapies are provided in primary care suggest that these may reduce referral and treatment costs, but prospective studies suggest that complementary medicine is an additional expense and does not substitute for orthodox care. For individual therapies, one thorough but retrospective study suggests that carefully targeted acupuncture may reduce referral costs for musculo-skeletal problems. One large pragmatic study of spinal manipulative therapy suggests that this treatment may reduce the societal costs of back pain, but four controlled trials found that manipulative therapy does not reduce the costs incurred by the back pain patients themselves or by their health insurance provider.
Conclusions: Spinal manipulative therapy for back pain may offer cost savings to society, but it does not save money for the purchaser. There is a paucity of rigorous studies that could provide conclusive evidence of differences in costs and outcomes between other complementary therapies and orthodox medicine. The evidence from methodologically flawed studies is contradicted by more rigorous studies, and there is a need for high quality investigations of the costs and benefits of complementary medicine.
White AR and Ernst E. Economic analysis of complementary medicine: a systematic review. Complementary Therapies in Medicine 8(2): 111-8. Jun 2000.

Issue 59

Huntley and Ernst, Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, Exeter, UK. conducted a review of complementary and alternative therapies for treating multiple sclerosis symptoms.
Background: Multiple sclerosis (MS) is a chronic disease of the central nervous system without a known cure. Thus the role of complementary and alternative therapies (CATs) for the management of symptoms lies in palliative care and this is borne out by the popularity of these treatments amongst MS sufferers.
Methods: This review is aimed at determining whether this use is supported by evidence of effectiveness from rigorous clinical trials. Database literature searches were performed and papers were extracted in a pre-defined manner.
Results: Twelve randomized controlled trials were located that investigated a CAT for MS: nutritional therapy (4), massage (1), Feldenkrais bodywork (1), reflexology (1), magnetic field therapy (2), neural therapy (1) and psychological counselling (2).
The evidence is not compelling for any of these therapies, with many trials suffering from significant methodological flaws. There is evidence to suggest some benefit of nutritional therapy for the physical symptoms of MS. Magnetic field therapy and neural therapy appear to have a short-term beneficial effect on the physical symptoms of MS. Massage/bodywork and psychological counselling seem to improve depression, anxiety and self-esteem.
Conclusions: The effectiveness for other CATs is unproven at this time. In all the CATs examined further investigations are needed in the form of rigorous large-scale trials.
Huntley A and Ernst E. Complementary and alternative therapies for treating multiple sclerosis symptoms: a systematic review. Complementary Therapies in Medicine 8(2): 97- 105. Jun 2000.

Liu and colleagues, College of Physicians and Surgeons, Columbia University, Department of Complementary Medicine Services, Presbyterian Hospital, School of Public Health, Columbia University, Columbia University, New York, NY, USA. ehl7@columbia.edu investigated use of alternative medicine by patients undergoing cardiac surgery.
Background: Complementary and alternative medicine (CAM) may influence cardiac surgical care by inducing coagulopathies and interacting with perioperative medications. The authors evaluated the significance of CAM use in an acutely ill cardiac surgical population and assessed the willingness of patients to reveal these activities to their physicians and surgeons.
Methods: A total of 376 consecutive patients undergoing preoperative or postoperative cardio-thoracic surgical evaluations at an urban academic medical center were approached to complete a survey regarding use and attitudes toward (CAM) between March and May 1998.
Results: Completion rate was 70% (n = 263). Respondents were predominantly male (72%), white (76%), and well educated (59%). The overall rate of CAM use was 75%, but excluding prayer and vitamins, which are often not considered CAM therapies, the rate was 44%. There was no correlation between the use of CAM and the parameters of gender, age, race, or education level. Only 17% responded that they had discussed CAM with their physicians, and 48% responded that they did not want to discuss the topic at all.
Conclusions: CAM is used as frequently in patients undergoing cardiac surgery, as in the general population. Physicians and surgeons should be aware that patients have no inherent predisposition toward or against using CAM, but that they are unlikely to volunteer their experience with it. The unwillingness of patients to discuss CAM with physicians has serious implications for their safety, especially in acute care situations.
Liu EH et al. Use of alternative medicine by patients undergoing cardiac surgery. Journal of Thoracic and Cardiovascular Surgery 120(2): 335-41. Aug 2000.

Babichenko, (no address given) investigated the use of acupuncture reflexotherapy in the treatment of hypertension patients. [Article in Ukrainian]
Methods: Acupuncture was used in a combination treatment of 110 patients with stage I to III hypertensive disease (HD). The acupuncture points used, followed the lines laid down in the traditional Chinese medicine (TCM), with results of Ryodoraku investigation and those of auriculodiagnosis supplying a guide to the choice of points taking into account the type of haemodynamics.
Results: In the authors experience, redundancy with the meridian of the liver, unlike TCM notions about dominance under HD syndrome of fire and wind in the liver, was found to be the case in 40 percent of the patients while redundancy with meridians of the heart and pericardium was recorded in 97 and 84 percent of the cases respectively. The use of acupuncture points in the neck collar region and head and of antique points along the meridians of the heart and liver were shown to be effective treatment having a beneficial effect on cerebral circulation.
Conclusions: Results of the clinical study suggest efficiency, expediency, and pathogenic value of acupuncture in the treatment of HD patients.
Babichenko MA. Acupuncture reflexotherapy in the treatment of hypertension patients. Lik Sprava (1): 95-7. Jan-Feb 2000.

Perry and Dowrick, Department of Primary Care, University of Liverpool, Liverpool, UK. investigated the use of, and attitudes towards complementary medicine among urban general practices in a socioeconomically deprived urban area.
Background: Complementary medicine appears to be an increasingly popular option amongst both doctors and patients. General practitioners in more affluent parts of Britain have showed considerable interest in its use.
Methods: A postal questionnaire survey of all general practice principles in Liverpool, using freepost envelopes and one reminder after 3 weeks. With respect to eight common complementary therapies, respondents were asked whether they treat with, refer to or endorse each therapy; for their views on NHS funding, effectiveness, adverse reactions, training needs, and theoretical validity, for each therapy.
Results: The response rate was 131/252 (52%), higher amongst women and doctors aged under 40. During the previous week 74 (56%) of respondents had been involved in complementary medical activity with their patients: 13% had treated directly, 31% had referred to and 38% had endorsed one or more complementary therapies. Acupuncture was most popular as an NHS option, and along with osteopathy and chiropractic was the therapy most highly regarded by respondents in terms of effectiveness. Homeopathy and hypnotherapy received a mixed reaction, while medical herbalism, aromatherapy and reflexology were viewed more sceptically. Sixty-two per cent of respondents reported successful outcomes of complementary treatments, compared with 21% reporting adverse reactions. Knowledge and training desires were highest for homeopathy and acupuncture. Respondents were generally uncertain about the theoretical validity of these therapies: 50% thought acupuncture had a valid basis, compared with only 23% for homeopathy and 8% for reflexology.
Conclusions: The degree of support for complementary medicine therapies amongst general practitioners in this socioeconomically deprived urban area was similar to that found elsewhere in Britain. These general practitioners appeared to tolerate high levels of clinical uncertainty, endorsing a wide range of therapies, despite little knowledge of their content or conviction of their validity.
Perry R and Dowrick CF. Complementary medicine and general practice: an urban perspective. Complementary Therapies in Medicine 8(2): 71-5. Jun 2000.
Comments: The above research indicates the widespread research currently underway to assess the use and efficacy of complementary medicine.

Issue 58

CHARD, TALLON and DIEPPE, Department of Social Medicine, University of Bristol, UK. J.a.chard@bristol.ac.uk reviewed (20 references) the epidemiology of research into interventions for osteoarthritis of the knee.
Methods: The authors aimed to assess the published research base for interventions for osteoarthritis of the knee joint by performing literature searches of the databases; Medline, Embase, ISI and The Cochrane Library, bibliographies of review articles and a postal questionnaire sent to members of the Osteoarthritis Research Society International. All articles were searched for treatment type, study methodology, statistical results, conclusions, funding source, researcher affiliations, and year of publication using a predetermined data extraction form.
Results: The authors reported marked changes in the literature over the period studied (1950-98) with a recent increase in trials of physical therapy, educational interventions and complementary treatments. However, overall most research involved drugs (59.1%) or was surgically related (25.6%). Most of the studies reported positive results (94%). Research on oral drugs was significantly more likely to produce a positive result than any other intervention (p<0.001). Commercially funded studies were significantly likely to produce a positive result than non-commercially funded research (p=0.0027).
Conclusions: The authors concluded that analysis of time trends indicates that the research agenda in osteoarthritis does shadow changes in consumer demands but, that there were significant gaps in the research base that need to be considered.
Chard et al. Epidemiology of research into interventions for the treatment of osteoarthritis of the knee joint. Annals of Rheumatic Disease 59(6): 414-8. Jun 2000.

HALL and GILES-CORTI, Department of Public Health, University of Western Australia surveyed Perth GPs to identify their knowledge, attitudes and referral patterns towards 10 complementary therapies.
Methods: The study was a descriptive, cross-sectional postal survey, conducted between July and August 1998 inclusive. A random selection of 200 male and 200 female Perth GPs listed in the Australian Medical Association database was made. Ten complementary therapies were listed in the questionnaire: acupuncture, hypnosis, meditation, spinal manipulation, yoga, homeopathy, herbal medicine, naturopathy, massage and aromatherapy.
Results: The response rate was 74.8% (n=282). Over 90% of these GPs reported having been approached by more than 30 patients seeking advice about complementary therapies in the past nine months. The majority were women and over the age of 35. Just less than half (132) of the respondents had undertaken studies in at least one of the listed complementary therapies, with over 60% reporting a wish for further training. Overall, 67.8% (191) of all respondents reported that they were in favour of GP referrals to complementary therapists. However, 56.1% (158) were against complementary therapies being included in private health insurance. In addition, 75% (211) of GPs surveyed had already formally referred a patient to one or more of the listed therapies, the most frequent of these being acupuncture, massage, meditation, hypnosis and spinal manipulation as part of their overall treatment.
Conclusions: The authors concluded that Perth GPs have a high level of interest in complementary therapies and that government regulation and registration of complementary therapies were seen as important. The authors suggest that given this high level of interest, undergraduate and postgraduate training for GPs could be considered as well as development of clinical guide lines.
Hall K and Giles-Corti B. Complementary therapies and the general practitioner. A survey of Perth GPs. Australian Family Physician 29(6): 602-6. Jun 2000.

KROUSE and KROUSE, University of Florida, Gainesville, USA. kroushj.valencia@shands.ufl.edu described the complementary therapeutic practices in patients with chronic sinusitis.
Background: Understanding patient use of alternative and complementary modalities to treat chronic health conditions such as sinusitis is an important component to holistic care.
Results: Eighty-one percent of patients with chronic sinusitis engaged in physical exercise to relieve symptoms. Additional complementary therapies utilized included herbal therapy (32%), chiropractic therapy (16%), biofeedback (13%), acupuncture (11%) and chelation therapy (7%). Medications were commonly used by patients (60%), especially those with severe symptoms.
Conclusions: The authors conclude that by recognizing and incorporating effective complementary therapies into care for chronic sinusitis, nurse practitioners may help patients to improve their clinical outcomes.
Krouse HJ and Krouse JH. Complementary therapeutic practices in patients with chronic sinusitis. Clinical Excellence in Nursing Practice 3(6): 346-52. Nov 1999.

SCHULZ, (no address given) volkschu@t-online.de r eviewed (21 references) the psychodynamic and pharmacodynamic effects of drugs.
Discussion: The therapeutic usefulness of medicines is usually measured in the artificial surroundings of a double blind clinical trial. The difference between the active drug and the placebo is accepted as being the same as the desired overall effect. Yet this yardstick can be misleading, as has become apparent from discussion which has recently arisen regarding the genuine and the illusory pharmacodynamic effects of synthetic antidepressants. Differentiated analysis of a representative number of placebo-controlled studies has shown that when used for depressive conditions, the pyschodynamic components contribute far more to the overall effect than do the pharmacodynamic components. In this respect, modern synthetic antidepressants are no better than hypericum products. Among other things, this means that for depressive states and similar indications, the safety, tolerability and acceptability of a medicine must be given much greater weight than its pharmacodynamic effects as assessed simply by testing against a placebo. The quantification of the two therapeutic components, as can be accomplished by a placebo-controlled drug trial, has revealed that the overall outcome of therapy for various important indications of this kind is attributable predominantly to the pyschodynamic component. It may reasonably be assumed that the contribution made by the psychodynamic effects to the overall therapeutic response will amount to only about 20-50%. These issues raise questions regarding the clinical relevance and economic value of placebo-controlled studies.
Schultz V. The pyschodynamic and pharmacodynamic effects of drugs: a differentiated evaluation of the efficacy of phytotherapy. Phytotherapy 7(1): 73-81. Mar 2000.

Comment: The conclusions of this research – that the components in a ‘placebo’ may contribute more than the ingredients in a medicine – at least regarding research into depression – raise exceedingly important issues regarding how research is conducted. So much for the sacred and highly touted double blind clinical trial!

TALLON, CHARD and DIEPPE, Department of Social Medicine, University of Bristol, UK described the relation between agendas of the research community and the research consumer.
Background: Previous studies have suggested that research agendas can be biased. In this report the authors investigated whether there was a mismatch between available research evidence.
Methods: The authors examined the research on interventions for the treatment of osteoarthritis of the knee joint by searching published and unpublished studies on interventions in this condition to assess the structure of the evidence base. Focus groups and a postal survey of research consumers were then undertaken to examine their views and research priorities.
Results: The review showed that the evidence base was dominated by studies of pharmaceutical (550, 59%), and surgical (238, 26%) interventions. 24 (36%) of 67 survey respondents ranked knee replacements as the highest priority for research, whereas 14 (21%) chose education and advice as their first choice.
Conclusions: The authors state that there is a mismatch between the amount of published work on different interventions, and the degree of interest of consumers. They conclude that if this mis-match is not addressed, then evidence-based medicine will not be representative of consumer needs.
Tallon D et al. Relation between agendas of the research community and the research consumer. Lancet 355;(9220): 2037-40. 10 Jun 2000.

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