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Natalie Lane is production editor
for journals with the Pharmaceutical Press, London
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In the December issue of Focus on Alternative and Complementary Therapies,
Martien Brands and David Colquhoun debate homoeopathy and whether it
is a relic of the past or a medicine of the future.
Mr Brands discusses the meaning of two principles of homoeopathy: the
rule of similars and the use of serially diluted and agitated (SDA) medicines.
The “similia” rule states that “a minute dose of a
substance can be used to treat a patient with a pattern of symptoms if
this is similar to a pattern provoked by the same substance in healthy
objects”. Mr Brands then highlights research that shows that toxically
damaged cells increase their regeneration capacity if stimulated by the
SDA form of the same toxin. In complexity theory, this means that a system
out of balance is highly sensitive to changes and minute stimuli, and
therefore the author details that this sensitivity issue shows the link
between the rule of similars and the use of SDA form of primarily toxic
substances. Following further discussion, Mr Brands concludes that molecular
biology and non-linear physics can now serve to explain the clinical
effects and benefits of two centuries of homoeopathy.
In contrast, Mr Colquhoun argues that there is no convincing evidence
about homoeopathy’s effectiveness. He considers that people believe
it works, not so much due to science but due to sociology and fashion,
and argues that people believe something is true regardless of whether
it is right or not. The current popularity of homoeopathy is a reversal
of the enlightenment values and the world we know, which was created
by Francis Bacon, Galileo, Isaac Newton and others. In the past 25 years,
it has become fashionable to advocate a return to the Dark Ages. Mr Culquhoun
believes that the “long-term historical trend for improvement is
clear” and that homoeopathy will pass into history as a “brief
hiccough”.
Echinacea
Formulations of Echinacea angustifolia roots lack preventive and treatment
efficacy against experimental rhinovirus infections, a study shows.
Three laboratory-derived extracts from E angustifolia were evaluated
for efficacy for prophylaxis and treatment of rhinovirus infections
relative to placebo. Volunteers received prophylaxis seven days before
a period of treatment, using one of three E angustifolia preparations
or a placebo. The main results showed that the mean infection frequency
or mean total symptom score was not influenced by E angustifolia prophylaxis
or treatment regimens. The conclusion is that “extracts of E
angustifolia root … do not have clinically significant effects
on infection with a rhinovirus or on the clinical illness that results
from it”.
A commentary details that the outcome of this trial attracted a high
level of media attention and likely stands as a “hotly debated
topic in phytomedicine in 2005”. The study was produced by a clinical
team highly experienced in assessment of rhinoviral infections and the
supplemental appendix material (22 pages) is noted as a comprehensive
example of phytochemical analyses in support of a clinical trial.
Yet concerns are raised about issues such as the study agents, with none
of the laboratory extractions of the three echinacea formulations corresponding
to any echinacea products available, and the fact that the echinacea
dose was less than one-third of that recommended by the World Health
Organization monograph on echinacea and recent monographs from the Canadian
Natural Health Products Directorate.
The commentator notes how the furore from this negative result is not
a surprise considering that products from “any one of the echinacea
species are among the world’s most widely selling botanical medicines” but
comments that the study raises more questions than answers. Was the study
population appropriate? What is the most appropriate echinacea product
for such a study? The authors used the most traditional plant, when many
commercial products are made from E purpurea or E pallida. The commentary
concludes with advice from another trial: “Avoid hand-to-hand transmission
of rhinovirus by frequent hand-washing with an appropriate cleanser during
the cold and flu season.”
Shark cartilage
A study conducted to determine if shark cartilage improves survival
and quality of life in patients with advanced cancer showed that currently
available shark cartilage supplements are not helpful. Eighty-eight
patients with incurable breast or colorectal cancer were given either
powdered shark cartilage or placebo. Outcome measures were survival,
toxicity and quality of life and no difference was observed in survival
time or quality of life. It was noted that low public enthusiasm about
shark cartilage meant accrual was slow, and patients had “difficulties
in tolerating the gastrointestinal toxicities”. Authors concluded
that shark cartilage had no efficacy for patients with advanced cancers.
The study’s commentator cites the study as an example of investigative
persistence and a cautionary tale — the authors proceeded with
a study that required special placebo development and dealt with many
patients withdrawing from the study from its completion. This “careful
randomised controlled trial was needed and no doubt will help end the
shark cartilage dietary supplement frenzy”.
It is detailed how laboratory studies showed that shark cartilage killed
cancer cells and thus, there was an initiation of clinical trials from
these promising laboratory results. Yet despite trials showing no benefit
from shark cartilage, product claims did not diminish and regulatory
actions followed. However, as the commentator notes, despite regulatory
actions and negative trials, shark cartilage products continue to remain
available.
The commentator concludes with details of how a cartilage derivative
has an apparent ability to destroy tumours by cutting off their blood
supply and how promising results from an early-phase clinical trial has
proceeded to two large, randomised trials currently under way. Final
observations detail how it was only when laboratory research isolated
active constituents that positive results were obtained, that “good
medical science proceeds according to tested design” and, finally,
warn of how too many dietary supplements are promoted as therapies for
cancer and other serious illnesses. The commentator concludes that, in
this instance, despite the sales hype surrounding shark cartilage, “background
laboratory research identified mechanisms of action and constituents
worthy of further study” — and hopes that cancer patients
may be the real beneficiaries this time. |
The
Pharmaceutical Journal