Complementary therapies in medicine
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Complement Ther Med · Apr 2013
ReviewUse of complementary and alternative medicine by children in Europe: published data and expert perspectives.
Few data document the use of complementary and alternative medicine (CAM) in Europe, with even fewer investigating use by children. ⋯ This precursor for further surveys indicates that CAM appears to be popular not only among adults in Europe, but also for children. Development of a pan-European definition of CAM use and CAM therapies are required to achieve surveys comparable between European countries. Additionally, more research investigating the efficacy and potential adverse effects of CAM therapies is needed because of increasing CAM use by children in Europe.
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The 'placebo effect' concept is intrinsic to the architecture of the double blind placebo randomised controlled trial (RCT), the oft quoted 'gold standard' method of clinical research whose findings are supposed to inform our understanding of the interventions used in clinical practice. The 'placebo effect' concept is often used in discussions of both clinical practice and clinical research, particularly when discussing why patients report improvements with complementary and alternative medicines (CAMs). Despite its frequent use, 'placebo effect' is a non-sequitur, thus confusion abounds. ⋯ Telling people that they might receive a placebo really complicates things. The uncertainty invoked by information that a placebo may be given can impact trial recruitment, the delivery of the intervention, and the reporting of outcomes, as can the 'meaning responses' invoked by other types of information provided to patients in standard RCT designs. Future CAM research should consider alternative RCT designs that help ensure that participants' experiences are uncontaminated by 'meaning responses' to information that they may receive fake treatments, i.e. placebos.
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Complement Ther Med · Apr 2013
Attitudes and beliefs of paediatric oncologists regarding complementary and alternative therapies.
The last decades have seen increasing patient use of complementary and alternative treatment methods (CAM) in paediatric oncology, too. However, there have been few scientific studies of paediatric oncologists' views and attitudes on CAM to date. We report the results of a cross-sectional questionnaire survey amongst paediatric oncologists in Germany. ⋯ In summary, the data presented here indicate that the majority of the responding German paediatric oncologists is open towards continuing medical education on CAM, not least in the interest of becoming more competent to advise their patients. This is in contrast to the fact that German paediatric oncologists currently tend not to actively bring up the topic of CAM in their consultations with parents. Younger doctors with shorter professional experience in paediatric oncology currently have a fundamentally more positive attitude towards CAM issues.
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Complement Ther Med · Apr 2013
ReviewComplementary and alternative medicine in paediatrics in daily practice--a European perspective.
Complementary and alternative medicine (CAM) is used by both adults and children in Europe. Diverse cultural, ethnic and historical preconditions in European countries result in broad differences between the types of CAM practiced, prevalence of CAM use and integration in the health system. To date, no survey of CAM availability to paediatric patients in Europe exists. ⋯ Every child in Europe has access to CAM treatment, mainly in private practices, whereas CAM outpatient clinics and inpatient services for children are rare. This is in contrast to adult treatment facilities, many of which offer CAM services, and the high percentage of European children using CAM.
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Complement Ther Med · Apr 2013
The placebo effect and its ramifications for clinical practice and research. Villa La Collina at Lake Como, Italy, 4-6 May 2012.
The purpose of this workshop was to further explore the implications of the placebo effect for both research and clinical practice from a variety of angles with a group of selected experts. ⋯ There are many remaining knowledge gaps with regard to the placebo response. The evolving knowledge challenges the paradigm of the placebo controlled RCT as a gold standard for demonstrating benefit of treatments. There are a number of pointers towards alternative research designs and paradigms worthy of further exploration. The evolving knowledge can contribute to the further development of a 'meaning orientated' and patient centred healthcare system.