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Ipos Facto (sic)

Facts, just give us the facts
No double standards
There's no funding for research
Level heads
Alternatives website
Electronic update

The new millennium brings with it a new disease, curious in that it is specific to healthcare: the Internet Print Out Syndrome (IPOS). No longer is it enough to turn on, tune in and drop out, now it is turn on, log on, and drop in on your GP and give the poor infantry something else to worry about from some crazy website.

Actually, it could be worse than that. Another pestilence stalks the land which can interact with IPOS. It is the alternative/complementary/natural medicine phenomenon. This one compounds IPOS by castigating all conventional medicine as wrong and hateful, and why don't YOU know, recognise and acknowledge that anything natural must be better, safer, and in tune with the world.

Facts, just give us the facts


Bandolier is fed up with reading the guff that comes with our national newspapers, TV, radio, and, increasingly, the Internet. It is time for a spirited defence, and there is only one defence - facts, just give us the facts. Facts depend on quality, and quality can help sort the wheat from the chaff.

In the first few months of 2000, Bandolier will search out systematic reviews of alternative therapies. Many good and many bad reviews have been published in the last few years. Bandolier will examine their quality and hold them up for inspection. To date experience shows four ways in which alternative therapy reviews can produce negative results:

  1. The review is awful. It fails to take account of sources of bias, includes non randomised studies, mixes outcomes or glissades over their clinical relevance. One such in this issue is a review of music therapy for dementia . It concludes that music therapy helps. That's nonsense because there is no good evidence.
  2. The review is great but the trials are awful. A superb review of randomised trials of ginseng demonstrates that almost no trials address the reasons why ginseng is used. Ginseng is used by the elderly. Most trials are in healthy youngsters: half are positive and half negative. No evidence for any effect.
  3. The review is great, the trials are great, but they demonstrate conclusively that there is no effect. Another superb review examines homeopathy for migraine and headache prophylaxis. It doesn't work.
  4. The review, despite comprehensive searching, finds no trials of sufficient quality to be considered for analysis. There is just no evidence to say whether a therapy works or not. It's just a guess.

No double standards


Therapies, conventional or unconventional, must be judged against the same standards. Just in case anyone thinks Bandolier has a bias, in this issue we have two systematic reviews of interventions for prevention of postoperative nausea and vomiting. A conventional therapy, metoclopramide , is without any useful effect at conventional doses. An unconventional therapy, P6 acupressure stimulation , works.

Bandolier has previously pointed out that there is good evidence for the effectiveness of some alternative therapies, especially herbal remedies like St John's Wort for depression, Chinese herbal remedies for irritable bowel syndrome, and ginkgo and feverfew, for example.

There's no funding for research


Another one of those goalpost moving arguments. Most systematic reviews of conventional or unconventional therapy end with a plea for more research. That's usually valid, because one of the major benefits of the systematic review process is to shed a little light on what we don't know.

But there's little enough funding for any research. However, alternative therapy attracts large numbers of people who pay a lot of money for it. Why not a levy for funding good trials. Or why don't we have "loser pays" funding from research organisations. If a trial with agreed design and outcomes meets a certain level of clinical or statistical significance, the research organisation pays. If not, the organisation representing a particular interest group. Seems a fair idea, and the Dutch did it for iridology.

Level heads


As an aid to demystification, we start this issue with a short step-by-step guide explaining why bogus therapies may appear to work. We also report on a study that pointed out that some trials from some countries, of conventional or unconventional therapies, appear to be universally positive . Negative outcomes just don't happen in China, Russia and a few other places.

Alternatives website


In the early part of 2000 we will build up a Bandolier Alternative Therapy website with the results of all the systematic reviews we can find. It's a lot of work, we have no funding for it, and offers of sponsorship would be welcome. We hope it will help patients and their carers in being a trusted source of useful information. It might even be useful for trading standards authorities.

Electronic update


Bandolier has to move from its present server. We are enormously grateful to those at the Oxford University Medical School who have helped over the last five years. A new home (or homes) is being sought, and we'll update you with developments.



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