Background: Despite increasing interest in complementary medicine worldwide, there has been no systematic large-scale documentation of medical homeopathic care. Objective: We therefore conducted a prospective cohort study aimed at characterizing patients seeking homeopathic care and their treatment. Patients and Methods: From September 1997 to June 1999, patients of all age groups who were visiting a homeopathic care center for the first time were included consecutively in the study and followed up for 24 months. Diagnostic procedures and prescriptions were documented using specific case report forms. Main Outcome Measures: Diagnoses (ICD-9), medical history, consultations, and prescriptions. Results: A total of 3,981 patients were included in the study, 2,851 adults (29% men, mean age 42.5 ± 13.1 years; 71% women, 39.9 ± 12.4 years) and 1,130 children (52% boys, 6.5 ± 3.9 years; 48% girls, 7.0 ± 4.3 years). Almost all patients suffered from chronic conditions for 10.3 ± 9.8 (adults) and 4.3 ± 3.7 years (children). The most frequent diagnoses were allergic rhinitis in adult males, headache in adult females, and atopic dermatitis in children (both genders). The typical homeopathic initial consultations took 117 ± 43 minutes for adults and 86 ± 36 minutes for children, not varying much between primary diagnoses. In the observed 2 years the patients had on average 8.6 ± 9.3 (adults) and 8.9 ± 9.6 (children) consultations, approximately 50% each by telephone and face-to-face. Physicians most often prescribed the classical ‘great’ remedies (like sepia, sulfur, natrium mur., lycopodium), but in total, nearly 600 different homeopathic remedies were used. Conclusions: Our study provides a wealth of data on the medical practice of classical homeopathy. In terms of treatment, polychrests are used frequently, although it should be noted that a large proportion of patients received ‘small remedies’ instead. Most patients are treated for chronic diseases. The present results will, in concert with follow-up outcome analysis, aid in determining the effectiveness of medical homeopathic practice.
Objective The goal of this paper is to describe the characteristics of physicians and their interventions in a large, multicentre randomised trial of acupuncture for tension-type headache known as ARTTTH, in order to enable acupuncturists to assess the study interventions. Methods Participating physicians were recruited whose qualifications met or surpassed those of physicians currently accredited for providing acupuncture by state health funding agencies in Germany. Semi-standardised treatment strategies for acupuncture and minimal acupuncture were developed in a consensus process with acupuncture experts. Atotal of 270 patients suffering from episodic or chronic tension-type headache were randomised to 12 sessions of semi-standardised acupuncture (three predefined 'basic' points, recommendations for additional points given, but individual choice of additional points possible), standardised minimal acupuncture (superficial needling of at least 5 of 10 predefined, bilateral, distant non-acupuncture points) or a waiting list. Forty two physicians, trained and experienced in acupuncture, from 28 centres in Germany participated in the trial. Results The median duration of acupuncture training of trial physicians was 500 hours (range 140 to 1350 hours). Physicians had 10 (<1 to 25) years acupuncture experience. The three 'basic' points (GB20, GB21 and LR3) were treated in 96%, 82% and 97% of sessions, respectively. Frequently treated optional points included LI4 (67%), SP6 (50%) and ST36 (46%). Ten of the 42 physicians stated that they would have treated patients differently outside the trial. The trial found a significant effect of acupuncture over waiting list but not over minimal acupuncture. Conclusions In general, trial physicians complied well with the predefined interventions. Arelevant minority of participating trial physicians stated that they would have treated patients differently outside the trial.
Most physical experiments of homeopathic preparations were performed with inadequate controls or had other serious flaws that prevented any meaningful conclusion. Except for those of high quality, all experiments should be repeated using stricter methodology and standardization before they are accepted as indications of special features of homeopathic potencies.
Background: We report on the study design and protocols of two randomized controlled trials (Acupuncture Randomized Trials = ART) that investigate the efficacy of acupuncture in the treatment of chronic low back pain and osteoarthritis of the knee, respectively. Objective: To investigate whether acupuncture is more efficacious than (a) no treatment or (b) minimal acupuncture in the treatment of low back pain and osteoarthritis. Design: Two randomized, controlled, multicenter trials with three treatment arms and a total follow-up time of 52 weeks. Setting: 30 practitioners and outpatient units in Germany specialized in acupuncture treatment. Patients: 300 patients will be included in each study. In the low back pain trial, patients will be included according to clinical diagnosis. In the osteoarthritis pain trial, patients will be included according to the American College of Rheumatology criteria. Interventions: Patients are randomly assigned to receive either (1) semi-standardized acupuncture (150 patients), (2) minimal acupuncture at non-acupuncture points (75 patients), or (3) no treatment for two months followed by semi-standardized acupuncture (75 patients, waiting list control). Acupuncture treatment consists of 12 sessions per patient over a period of 8 weeks. Main Outcome Measure: The main outcome measure is the difference between baseline and the end of the 8-week treatment period in the following parameters: pain intensity as measured by a visual analogue scale (VAS; 0–100 mm) in the low back pain trial and by the Western Ontario and McMaster Universities Osteoarthritis Score (WOMAC) in the osteoarthritis trial. Outlook: The results of these two studies (available in 2004) will provide health care providers and policy makers with the information needed to make scientifically sound assessments of acupuncture therapy.
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