Forschende Komplementarmedizin最新文献

Electromagnetic Bioinformation in the Frequency Region between 100 Hz and 100 kHz? A highly sensitive measurement amplifier (BIT device) was constructed in order to detect possible electromagnetic biosignals in the frequency region between 100 Hz and 100 kHz. Even when working with the highest amplification mode of the BIT device, no endogenous electromagnetic biosignals could be detected on the test persons, but only well-known EMG signals. If the BIT device worked in a feedback mode, electromagnetic oscillations beween 1.7 and 2.9 kHz could be generated and oscilloscopically detected; these oscillations are caused by the oscillator system 'BIT - man', depending on the impedance of the human body. Biological effects of the impedance-depending oscillations were investigated in a simple randomized double-blind study. Three anamnestically healthy persons were treated 20 times with their specific oscillations. The physiological effects of this treatment were measured by pulse plethysmography. Nonlinear analysis of the time series indicated significant changes in pulse dynamics of one person. Linear analysis of heart rate variability showed no statistical significance. Our device was only designed for the project described below. It is, therefore, evident that the research results presented in this paper cannot be applied to any of the therapy devices at present on the market.

The aim of this overview is to discuss the usefulness of two research tools often advocated in complementary medicine: the n = 1 study and case series. These methodologies are defined and their advantages and disadvantages are outlined. It is concluded that both designs have advantages and disadvantages. For testing the efficacy/effectiveness of complementary therapies neither design will lead to conclusive, generalizable results. Yet both methodologies can be valuable adjuncts to other types of investigation.

Empiric and Dogmatic 'Seasons' in the Progress of Medical ScienceThe current 'postmodern' times are not simply permissive towards any theory whatever. In medicine, the 'external validity' of theories and the exact place of various healing schools has become an important subject. 'Critical appraisal' of the empiric evidence for treatment benefit in all areas of medicine, conventional or unconventional, will separate the wheat from the chaff. Pluralistic evidence-based medicine constitutes the flail for achieving this task. This happens in late summer. Later in winter, the chaff of useless medicine will decay; a new therapeutic spring will only be possible when the current task of identifying effective and beneficial treatments in all areas and of abandoning useless therapies will be fulfilled. The current primacy of the empiric study of medicine, rather than the dogmatic, should not be misunderstood as a pure empirism. Rather, we are in the empiric 'season'. Questions about mechanisms of action will remain, but will retreat to the back of the mind for some time.

OBJECTIVES: To review the effectiveness of prayer as an additional intervention for those with health problems already receiving standard medical care. SEARCH STRATEGY: Electronic Searches of Biological Abstracts, CINAHL, The Cochrane Controlled Trials Register, EM-BASE, MEDLINE, PsycLIT, and Sociofile were undertaken. All references of articles selected were searched for further relevant trials. SELECTION CRITERIA: Randomised and quasi-randomised trials of personal, focused, committed and organised intercessory prayer on behalf of anyone with a health problem were considered. Outcomes such as achievement of desired goals, death, illness, quality of life and well-being for the recipients of prayer, those praying and the caregivers were sought. DATA COLLECTION AND ANALYSIS: Studies were reliably selected and assessed for methodological quality. Data were extracted by 4 reviewers working independently. Dichotomous data were analysed on an intention-to-treat basis, and continuous data with over 50% completion rate are presented. MAIN RESULTS: There was no evidence that prayer affected the numbers of people dying from leukaemia or heart disease (OR 0.64, CI 0.32-1.27), or that it decreased coronary care complications (OR 1.05, CI 0.49-2.26) or the time participants stayed in hospital. There were significantly fewer 'intermediat//poor outcomes' for those with heart disease in the prayed-for group (OR 0.49, CI 0.30-0.80), and this finding was robust to some changes in definition. CONCLUSIONS: This review provides no guidance for those wishing to uphold or refute the effect of intercessory prayer on the outcomes studied in the available trials. Therefore, in the light of the best available data, there are no grounds to change current practices. There are very few completed trials of the value of intercessory prayer. The evidence presented so far is interesting enough to justify further study. If prayer is seen as a human endeavour it may or may not be beneficial, and further trials could uncover this. It could be the case that any effects are due to elements beyond present scientific understanding that will, in time, be understood. If any benefit derives from God's response to prayer it may be beyond any such trials to prove or disprove.

Physicians throughout medical history knew three possible ways to explain the association between treatment and cure: 1. the beneficial effect of the treatment itself, 2. the healing power of nature, and 3. the placebo effect. In the modern definition by Grünbaum, a treatment is a placebo when the effect cannot be explained by the theory that describes its activity. In clinical practice the placebo phenomenon is commonly misunderstood. Placebos are given to prove the patient wrong or to punish him. Nevertheless, most clinical pain can be reduced to at least half of its intensity by placebos. Also cough, headaches, asthma and other ailments can thus be relieved. Explanatory theories are often much narrower in focus than the phenomenon they seek to explain. A Meaning Model could offer new possibilities, as it includes the doctor-patient relationship, belief systems, social support, and feelings of mastery over the symptoms. One way to make such a model visible is the exploration of the deep-seated cultural assumptions about illness in different countries.

What Is Successful Treatment? What Is Success in Therapy? - Observations on Psychotherapy ResearchThe author raises the following questions: What are the criteria for the evaluation of successful psychotherapeutic treatment? Which are the suitable research methods for the assessment of psychotherapeutic success? He proposes a research paradigm based on multiple criteria and multiple methods. Psychotherapeutic treatment success must be assessed on different levels: aetiology of disease, disease as nosologic category (e. g. depression), symptomatology, consequences (psychic, physical, social, economical) of disease. He further develops a research logic that is multimethodical: Results from different research methods must be aggregated on the basis of convergent findings. The three 'key research methods' in psychotherapy research are: single-case studies, controlled trials, naturalistic catamnestic research. Statements about any psychotherapeutic method or intervention strategy are only valid when results from these different study types converge. It may be a very severe bias when findings from only one study type (e. g. controlled trials) are generalised as a final verdict on certain psychotherapeutic methods.

OBJECTIVE: To establish whether the choice of the placebo treatment used may influence the outcomes of clinical trials on acupuncture or not. DESIGN: A meta-analysis of outcomes according to the choice of the placebo. Attention was focused on the placebo design of 117 clinical, controlled trials found after an extensive search. Studies comparing acupuncture to no treatment or a reference treatment were discarded from the analysis. A set of 90 publications could be classified into one of two groups: i) Clinical studies with sham acupuncture as placebo, which consists of needling outside the meridian, but near to classical acupoints. This group of 45 trials was classified as energetic placebo model (EPM). ii) 45 studies using a placebo treatment consisting of needling within a segmental zone far enough away from the active points were classified as neurophysiological or metameric placebo model (MPM). In both groups of studies the proportions of significant results and the distribution of outcomes characterized by nonsignificant results with improvements greater than 35% in both groups of patients were assessed by the chi-square test. RESULTS: The proportion of meaningful results was significantly higher in the MPM group [73.33% (33/45)], while only 33.33% (15/45) of such results were found in the EPM group (p < 0.03). In the EPM group 24/30 studies showed nonsignificant results with improvements greater than 35% in both groups of patients, while in the MPM group only 20% (6/30) of studies with this outcome could be observed (p < 0.05). CONCLUSION: Studies using EPM as placebo failed more frequently to show any differences between real acupuncture and placebo treatment than those using MPM as placebo. On the other hand, sham acupuncture appears almost as active as 'real' acupuncture. These results suggest that the design and the way of performing the placebo procedure determine the outcome, i. e. success or failure of a clinical trial in obtaining differences among the patients groups, in case they actually exist.

A New Systematic Approach to Problems in General Practice and Its Consequences for ResearchMedical research finds its legitimation by improving the conditions of everyday life of sick people. Apart from purely biological effects, a lot of influence factors contribute to the outcomes of medical interventions in terms of 'social effectiveness' for the patient. These may concern the way a doctor or the medical system tackles the patient's problem as well as the relevant social and psychological conditions, the factors referring to work or family, and the patient's personality, health beliefs, expectations etc. Thus a specific transformation process must take place in order to achieve a real health gain as perceived by the patient. Until now medical research has developed impressive new therapeutic principles, however, it has widely neglected the processes of transfer and implementation and the field of its effectiveness for the patient apart from the biological effects. It still remains poorly understood that the confrontation of medical endeavours with the patient's life situation provokes a process of conflict and adaption which essentially contributes to the success or failure of medical practice. Here new fields of research for general practice arise. We should investigate the principles examining the effectiveness of medical interventions in the area of conflict between medicine and patient and the general practitioner's mediatory role in this process. This field of research is determined by the coordination of the following three elements forming a primary care scheme of action: 1. hierarchy of general therapeutic goals, 2. primary care description of health problems, 3. dimensions of possible help.

The Concept of Pragmatic Clinical Research or the End of Discussion about 'Placebo' and 'Specific Effects&rsquoThe reorientation of clinical research towards the questions of treatment benefit (beyond the question of treatment efficacy) and of how much clinical trials represent actual practice (external validity) is the timely path to clinical research questions of real interest and importance. Postmodern 'anything goes' makes it possible to also consider thus far looked down on placebo effects as valuable, however, it requires the precise documentation of the external validity of such effects. Not disease as such, but the disease context, not therapy as such, but the therapy context, not the patient as such, but the patient context, not a test as such, but the test situation have become the important focuses of clinical research. In respect to test results current medicine has to recognize its illiterate mystification of allegedly 'objective' and 'hard' data. The patient context can determine whether an 'efficacious' therapy is beneficial or harmful, and thus, it is the proper definition of the patient context which makes medicine scientific, no matter how 'objective' or 'subjective' the effect of therapy is. The consideration of the therapy context leads to the important distinction between efficacy and effectiveness (or benefit), and it becomes intelligible that the randomised controlled trial in its traditional design as the placebo-controlled double-blind trial is limited to the evaluation of an agent theory. The evaluation of treatment effectiveness requires more pragmatic trials which study treatment operations and not isolated components and which may even compare entire treatment strategies. Pragmatic clinical trials, in future, will not only allow the study of 'pathogenesis blockers'., but also the study of 'salutogenetic' interventions working with the formation of the host. The focus of attention and research in the new school of evidencebased medicine with clinical epidemiology as its basic science (if not superficially understood as mere literature medicine) has long ago been identified as illness as the product of host, disease and environment. The dispute about 'placebo' and 'specific effects', in the meantime, has become obsolete.