Sarah Brien

An investigation was made into the hypothesis that chronic ethanol ingestion disturbs the metabolism of tryptophan which is reflected by alterations in the urinary excretion of the metabolites 5-hydroxyindoleacetic acid (5-HIAA), anthranilic acid (AA) and indoleacetic acid (IAA). In particular, we investigated whether experimental chronic alcoholism is associated with a decrease in the tryptophan metabolite ratios as suggested in the literature. Male Wistar rats were chronically fed a nutritionally-complete liquid diet in which ethanol comprised 35% of total calories: controls were pair-fed identical amounts of the same diet in which ethanol was replaced by isocaloric glucose. At 6 weeks, 24 h urine samples were collected for the analysis of tryptophan, 5-HIAA, AA and IAA by HPLC. During ethanol-feeding there were reductions in the daily urinary excretion (i.e. mumol/24 h) of tryptophan (-57%, P = 0.026) and concomitant increases in 5-HIAA excretion (62%, P = 0.057). Expression of data in terms of lean tissue mass (i.e. urinary creatinine) revealed identical conclusions. An analysis was performed on the molar ratios of these urinary analytes. The tryptophan: total metabolite ratio was significantly decreased (by -53%), but the AA: total metabolite ratio was not significantly altered (P = 0.102). The ratios 5-HIAA/AA and 5-HIAA/IAA were slightly increased, but they did not attain statistical significance (P > 0.351). It was concluded that chronic ethanol feeding is associated with significant changes in the urinary excretion of tryptophan and its related metabolites.(ABSTRACT TRUNCATED AT 250 WORDS)

A number of authors have recently discussed the possible role entanglement in homeopathy. Walach et al have published a homeopathic proving which they interpreted as demonstrating entanglement between placebo and verum groups in a proving. The lack of a ‘run-in’ period was a weakness of this trial.We present further results of our proving of Belladonna which show that subjects who reported symptoms during the placebo run-in period (‘presentiment provers’) were more likely to report symptoms during the treatment period. This data suggests and the observations of Walach et al may be explicable by conventional mechanisms including differential reporting and constitutional type

Homeopathic pathogenetic trials (or provings) provide the foundations for the clinical practice of homeopathy. The most recent review of proving studies indicated that provings are generally of poor methodological quality. Methods to improve the quality and scientific rigour are needed to critically assess the clinical basis of homeopathy. This article describes a methodology using a symptom diary with a selection of predefined remedy specific symptoms (proving questionnaire). The proving questionnaire was developed as an alternative to the traditional qualitative proving methods in an attempt to provide a quantitative method that could rigorously validate the original provings. This article considers the advantages and disadvantages of this approach and provides suggestions for future work in this area.

Osteoarthritis (OA) is a highly prevalent musculoskeletal disorder. Conventional treatment (i.e., the use of nonsteroidal anti-inflammatory drugs-NSAIDs) is associated with well-documented adverse effects. Devil's Claw (Harpagophytum procumbens) a traditional South African herbal remedy used for rheumatic conditions, may be a safer treatment option. To date, 14 clinical trials have assessed its efficacy/ effectiveness in OA. To address the two main questions of importance to clinicians: (1) Does Devil's Claw work for the treatment of OA, and (2) Is it safe? A review of the literature on Devil's Claw and OA from 1966 to 2006 was performed using multiple search databases, monographs, and citation tracking. Relevant trials in all languages were identified and included. Both internal validity (i.e., adequacy of the dosage and period of treatment for this condition, reporting of randomization, rates of dropout, blinding, and statistical analysis) and external validity (i.e., inclusion/ exclusion criteria, baseline characteristics of the study populations, trial setting, and the appropriateness of the outcome measures of the trials) were assessed. Fourteen studies were identified: eight observational studies; 2 comparator trials (1 open, the other randomized to assess clinical effectiveness); and 4 double-blinded, placebo-controlled, randomized controlled trials to assess efficacy. Many of the published trials lacked certain important methodological quality criteria. However, the data from the higher quality studies suggest that Devil's Claw appeared effective in the reduction of the main clinical symptom of pain. The assessment of safety is limited by the small populations generally evaluated in the clinical studies. From the current data, Devil's Claw appears to be associated with minor risk (relative to NSAIDs), but further long-term assessment is required. The methodological quality of the existing clinical trials is generally poor, and although they provide some support, there are a considerable number of methodologic caveats that make further clinical investigations warranted. The clinical evidence to date cannot provide a definitive answer to the two questions posed: (1) Does it work? And (2) is it safe? A definitive high-quality trial that addresses the necessary methodologic improvements noted is needed to answer these important clinical questions.

A homeopathic proving states that when a homeopathic remedy is given to a healthy person, they will experience symptomatic effects specific to that remedy. The aim of this study was to assess if attitudes about complementary and alternative medicine (CAM) predicted proving outcome. An exploratory study nested in a double blinded randomized controlled proving trial of the remedy Belladonna C30. Two hundred and six (206) healthy subjects took part in the reproving trial of whom 29 (14%) proved. Subjects completed the Attitudes to Alternative Medicine Scale prior to participating in the proving trial (n = 206) and after the proving trial was completed (n = 77). The primary outcome was whether attitude to CAM predicted proving outcome. Attitudes about CAM at baseline did not predict proving outcome (chi2 = 35.34, df = 36, p = 0.50) and attitudes to CAM did not alter after taking part in the proving trial for either provers or non provers. Subjects classified as being provers in a proving trial did not have significantly different attitudes about CAM than nonprovers. The experience of proving the study remedy did not alter the prover's attitudes about CAM.

Kinesiology is a diagnostic, therapeutic complementary therapy utilising subtle change in manual muscle testing results to evaluate the body's energetic balance and select healing modalities. Anecdotal evidence suggests kinesiology is helpful, therefore we wished to critically review the literature. (1) To ascertain if diagnostic accuracy including inter-examiner reliability has been established. (2) To review whether there is evidence for its therapeutic effectiveness. (3) To critically assess the quality of relevant studies. Electronic databases were searched. Diagnostic accuracy studies were analysed and scored for methodological quality and quality of reporting using the quality assessment tool for studies of diagnostic accuracy included in systematic reviews (QUADAS) and the Standards for Reporting of Diagnostic Studies (STARD). Clinical studies were analysed for methodological quality using the JADAD scale and for quality of reporting using the Consolidated Standards of Reporting Trials (CONSORT). 22 original relevant studies were identified. Their methodology was poor. Items reported on QUADAS scored 1-11 out of a possible 14, STARD scores were between 6-13 out of 25, JADAD scores were all 0 out of 5 and CONSORT 4-6 out of 22. Consequently, we were unable to answer any of our research questions. There is insufficient evidence for diagnostic accuracy within kinesiology, the validity of muscle response and the effectiveness of kinesiology for any condition. The standards of reporting were low. We recommend a pragmatic study of the effectiveness of kinesiology as the most appropriate initial step to determine whether kinesiology has any clinical value.

Kinesiology is a complementary therapy assessing subtle change in manual muscle testing results to select individualised treatments. We report the exploratory 2-stage development and pilot of a sham kinesiology treatment for use in a clinical trial to evaluate the specific effects of this intervention. 1. To design, pilot and assess the credibility of a sham kinesiology treatment in a kinesiology-aware population. 2. To pilot the sham kinesiology in a cross-over study of sham versus real kinesiology, and to make an exploratory assessment of its credibility in a kinesiology-naïve population. 1. 10 kinesiology-aware volunteers received a specially designed sham treatment weekly for 5 weeks which was subject to a credibility assessment. 2. 10 kinesiology-naïve patients with low back pain were randomised to receive 4 real and 4 sham treatments in a cross-over design; the treatments were subject to a credibility assessment. 100% of participants found the sham protocol a credible treatment as measured by the credibility questionnaire. 100% of patients having real treatment first did not recognise that the second set of treatments were sham. Small numbers precluded the use of formal statistical tests. In this small sample it appeared feasible to deliver an apparently credible sham kinesiology treatment. This feasibility study has allowed us to develop a sham treatment for use in a larger prospective clinical trial of kinesiology in patients with low back pain.

There has been a threefold increase in the proportion of children among patients visiting homeopaths in Norway from 1985 to 1998. As no study has investigated the reasons for this increase, the aim of the present study was to explore why parents take their children to homeopaths. In this qualitative study, parents who had taken their child to a homeopath for the first time during the last 3 months were interviewed in depth using a semi-structured interview guide. The interviews were analysed using thematic analysis based on techniques from grounded theory. 9 parents were interviewed. Parents consulted a medical doctor to clarify how serious their child's health condition was, and sought treatment from a homeopath if the symptoms were not dangerous. Personal recommendations or personal experience of homeopathy were identified as being a main factor that triggered seeking treatment specifically from a homeopath. The reasons they sought an alternative, or rather complement, to conventional medical treatment were: they did not wish to give their child allopathic medication; they wanted to find an alternative treatment to their child's currently prescribed allopathic medication; they had ceased conventional medication due to its side effects; to obtain treatment whilst waiting for a problem to be assessed; or they were not offered any treatment by their medical doctor. Parents took their child to a homeopath due to experiences with the medical encounter or treatment and due to recommendations or own personal experience.

Understanding how homeopaths make clinical decisions is important in terms of optimising patient care, yet currently little is understood about this process. Most current literature investigating decision-making has focussed on conventional medicine; to date only two studies, both quantitative, have explored this area, with both studies investigating this in homeopathy. The aim of this qualitative study was to explore how homeopaths make prescribing decisions primarily during their first consultation with a patient. In-depth, semistructured, face to face interviews were carried out with 14 private homeopaths working in private practice. Interpretative phenomenological analysis (IPA) was carried out on the data by 3 researchers. Cognitive processes that homeopaths used in decision-making emerged from the analysis included the use of pattern recognition (P), hypothetico-deductive reasoning (H) and intuition (I), which led to a precise remedy match (R-M). Four themes emerged from the data: three related to the process of making a decision; one theme to those factors that influence this process. These themes fitted into a decision-making model, which we describe: the P.H.I.RM decision-making model. Two further themes emerged, which contributed to the model: the practitioners' awareness of avoiding major bias and the role of the patient practitioner relationship in influencing decision-making. The P.H.I.R-M decision-making model describes how homeopathic practitioners' used an evidence-based process to make decisions. This study also contributes more weight to the accumulating evidence that intuition is a valuable component of decision-making for homeopathic practitioners.