ARE ALTERNATIVE TREATMENTS EFFECTIVE? ISSUES & METHODS INVOLVED IN MEASURING EFFECTIVENESS OF ALTERNATIVE TREATMENTS

This paper reviews common research methods which have been used in alternative medicine. We focus on a case series method called the before-after treatment experimental design. How this method can be used by practitioners to measure the effectiveness of their treatments is explored in depth. We address what variables should be measured before, during and after treatment. References to commonly used measurement instruments for physical, emotional and spiritually based variables are included

Dekonstruktion af Placebo Effekten og fundet af Betydningsrespons

We provide a new perspect ve with which to understand what for a half century has been known as the »placebo effect.« We argue that, as currently used, the concept includes much that has nothing to do with placebos, confusirig the most interesting and important aspects of the phenomenon. We propose a new way to understand those aspects of medical care, plus a broad range of additional human experiences, by focusing on the idea of »meaning,« to which people, when they are sick, often respond. We review several of the many areas in medicine in which meaning affects illness or healing and introduce the idea of the »meaning response.« We suggest that use of this formulation, rather than the fixation on inert placebos, will probably lead to far greater insight into how treatment works and perhaps to real improvements in human well-being

A systematic review of the quality of homeopathic clinical trials

BACKGROUND: While a number of reviews of homeopathic clinical trials have been done, all have used methods dependent on allopathic diagnostic classifications foreign to homeopathic practice. In addition, no review has used established and validated quality criteria allowing direct comparison of the allopathic and homeopathic literature. METHODS: In a systematic review, we compared the quality of clinical-trial research in homeopathy to a sample of research on conventional therapies using a validated and system-neutral approach. All clinical trials on homeopathic treatments with parallel treatment groups published between 1945–1995 in English were selected. All were evaluated with an established set of 33 validity criteria previously validated on a broad range of health interventions across differing medical systems. Criteria covered statistical conclusion, internal, construct and external validity. Reliability of criteria application is greater than 0.95. RESULTS: 59 studies met the inclusion criteria. Of these, 79% were from peer-reviewed journals, 29% used a placebo control, 51% used random assignment, and 86% failed to consider potentially confounding variables. The main validity problems were in measurement where 96% did not report the proportion of subjects screened, and 64% did not report attrition rate. 17% of subjects dropped out in studies where this was reported. There was practically no replication of or overlap in the conditions studied and most studies were relatively small and done at a single-site. Compared to research on conventional therapies the overall quality of studies in homeopathy was worse and only slightly improved in more recent years. CONCLUSIONS: Clinical homeopathic research is clearly in its infancy with most studies using poor sampling and measurement techniques, few subjects, single sites and no replication. Many of these problems are correctable even within a "holistic" paradigm given sufficient research expertise, support and methods

NONLINEAR EFFECTS OF NANOPARTICLES: BIOLOGICAL VARIABILITY FROM HORMETIC DOSES, SMALL PARTICLE SIZES, AND DYNAMIC ADAPTIVE INTERACTIONS

Researchers are increasingly focused on the nanoscale level of organization where biological processes take place in living systems. Nanoparticles (NPs, e.g., 1-100 nm diameter) are small forms of natural or manufactured source material whose properties differ markedly from those of the respective bulk forms of the “same” material. Certain NPs have diagnostic and therapeutic uses; some NPs exhibit low-dose toxicity; other NPs show ability to stimulate low-dose adaptive responses (hormesis). Beyond dose, size, shape, and surface charge variations of NPs evoke nonlinear responses in complex adaptive systems. NPs acquire unique size-dependent biological, chemical, thermal, optical, electromagnetic, and atom-like quantum properties. Nanoparticles exhibit high surface adsorptive capacity for other substances, enhanced bioavailability, and ability to cross otherwise impermeable cell membranes including the blood-brain barrier. With super-potent effects, nanoforms can evoke cellular stress responses or therapeutic effects not only at lower doses than their bulk forms, but also for longer periods of time. Interactions of initial effects and compensatory systemic responses can alter the impact of NPs over time. Taken together, the data suggest the need to downshift the dose-response curve of NPs from that for bulk forms in order to identify the necessarily decreased no-observed-adverse-effect-level and hormetic dose range for nanoparticles

Meeting the Challenge of a More Person-centered Future for US Healthcare

Person-centered care is a burgeoning social movement and a mission statement for modern healthcare. However, it is not a new idea. Often called the father of modern medicine, William Osler said, “The good physician treats the disease; the great physician treats the patient who has the disease.” Social movements typically begin with common issues brought forward by an affected group whose members share a common interest in a cause. Health-based social movements (HSMs) such as the women\u27s health movement and breast cancer activism have significantly impacted health and social policy. The movement toward person-centeredness grew from a number of narrow interest-based activists to a more general movement for healthcare reform from objections to both medicalization and medical paternalism, and the demands for increased autonomy and choice which arose from the cultural and political shifts of the 1960s. In addition, the increasing prevalence of long-term chronic conditions has led to the necessity of new models to manage disease and disability that empower people living with the health condition to gain greater control of their health and healthcare decisions

To what extent are surgery and invasive procedures effective beyond a placebo response? A systematic review with meta-analysis of randomised, sham controlled trials

Objectives: To assess the quantity and quality of randomised, sham-controlled studies of surgery and invasive procedures and estimate the treatment-specific and non-specific effects of those procedures. Design: Systematic review and meta-analysis. Data sources We searched PubMed, EMBASE, CINAHL, CENTRAL (Cochrane Library), PILOTS, PsycInfo, DoD Biomedical Research, clinicaltrials.gov, NLM catalog and NIH Grantee Publications Database from their inception through January 2015. Study selection We included randomised controlled trials of surgery and invasive procedures that penetrated the skin or an orifice and had a parallel sham procedure for comparison. Data extraction and analysis Three authors independently extracted data and assessed risk of bias. Studies reporting continuous outcomes were pooled and the standardised mean difference (SMD) with 95% CIs was calculated using a random effects model for difference between true and sham groups. Results: 55 studies (3574 patients) were identified meeting inclusion criteria; 39 provided sufficient data for inclusion in the main analysis (2902 patients). The overall SMD of the continuous primary outcome between treatment/sham-control groups was 0.34 (95% CI 0.20 to 0.49; p<0.00001; I2=67%). The SMD for surgery versus sham surgery was non-significant for pain-related conditions (n=15, SMD=0.13, p=0.08), marginally significant for studies on weight loss (n=10, SMD=0.52, p=0.05) and significant for gastroesophageal reflux disorder (GERD) studies (n=5, SMD=0.65, p<0.001) and for other conditions (n=8, SMD=0.44, p=0.004). Mean improvement in sham groups relative to active treatment was larger in pain-related conditions (78%) and obesity (71%) than in GERD (57%) and other conditions (57%), and was smaller in classical-surgery trials (21%) than in endoscopic trials (73%) and those using percutaneous procedures (64%). Conclusions: The non-specific effects of surgery and other invasive procedures are generally large. Particularly in the field of pain-related conditions, more evidence from randomised placebo-controlled trials is needed to avoid continuation of ineffective treatments

Z-Spec: a broadband direct-detection millimeter-wave spectrometer -- instrument status and first results

We report on the status of Z-Spec, including preliminary results of our first astronomical measurements. Z-Spec is a cryogenic, broadband, millimeter-wave grating spectrometer designed for molecular line surveys of galaxies, including carbon monoxide redshift measurements of high-redshift submillimeter sources. With an instantaneous bandwidth of 185-305 GHz, Z-Spec covers the entire 1 mm atmospheric transmission window with a resolving power of 200-400. The spectrometer employs the Waveguide Far-Infrared Spectrometer (WaFIRS) architecture, in which the light propagation is confined within a parallel-plate waveguide, resulting in a minimum mechanical envelope. Its array of 160 silicon-nitride micromesh bolometers is cooled to below 100 mK for background-limited performance. With its sensitivity, broad bandwidth, and compactness, Z-Spec serves as a prototype for a future far-IR spectrometer aboard a cold telescope in space. Z-Spec successfully demonstrated functionality with a partial array of detectors and warm electronics during a week-long engineering run at the Caltech Submillimeter Observatory in June, 2005. We describe the instrument performance evaluated at the telescope and in subsequent laboratory tests and compare these results with design specifications. Following several modifications we returned to the telescope in April, 2006. We present a preliminary astronomical spectrum and discuss our plans to improve sensitivity and throughput to achieve our ultimate science goals