順勢療法討論區 Homeopathy Discuss!

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admin 發表於 2016-3-22 19:38:57 | 顯示全部樓層 |閱讀模式
以下是順勢療法研究所(Homeopathy Research Institute)對有關Posadzki「順勢療法的副作用」一文的回應:

Tournier A, Roberts ER, Viksveen P.Adverse effects of homeopathy: asystematic review of published case reports and case series - comment byTournier et al. Int J Clin Pract. 2013 Apr;67(4):388-9. doi:10.1111/ijcp.12138.

To the Editor:

We write to express grave concern about therecent article by Posadzki et al. [1] in which the authors claim to haveidentified 1159 patients who have experienced mild-to-severe adverse effects(AE) caused either directly or indirectly by homeopathic treatment, includingfour fatalities.
我們來信對最近一篇由Posadzki等人寫的文章表示重大的關注。 [1],其中,作者聲稱已經確定1159名病人因順勢療法治療而出現直接或間接、輕度至重度的不良反應(AE),包括四死亡。

Our concern about this systematic review is notthat it highlights the potential for AE from homeopathy, as it would be mostpeculiar for any medical intervention to be entirely harm-free. Rather, onscrutiny of the article, we have discovered that the reporting of publishedcases, as well as the methods and analyses applied by the authors are seriouslyflawed, leading to unreliable conclusions about the relative safety ofhomeopathy.


Detailed examination of the 37 original articlescited by Posadzki and colleagues has uncovered numerous striking errors. Asthere are too many to mention in this comment, we draw your attention to justsome examples of our key concerns below.



In reporting on four cases of AEs published byIbsen et al., Posadzki and colleagues categorise these as ‘likely’ to have beencaused by homeopathy[23]. However, there is actually no reference made tohomeopathy whatsoever in the Ibsen article. The word ‘homeopathy’ only appearedin the English abstract as an incorrect translation of the term ‘alternativetreatment’.

四個不良事件的案例來自Ibsen等人發表的報告,Posadzki及其同事歸類這些為「可能」是由順勢療法引起的。但是,在Ibsen等人發表的文章中,實際上完全沒有提及有關順勢療法的案例。「順勢療法」這個詞只出現在報告的英文摘要中,其翻譯者錯誤地把「替代治療」(alternativetreatment) 翻譯為「順勢療法」(Homeopathy)

Of even greater concern is the reporting of acase report by Geukens[20] of cure by homeopathy, which has been reported byPosadzki et al. as a case of homeopathy causing ‘heart disease and bladdercancer’. In actual fact, the patient was cured from his initial symptoms ofvertigo and heart disease using homeopathic medicines; he then presented 7years later with cancer of the bladder. It is difficult to see how thecausality of the cancer could be attributed to the successful treatment of theheart-condition. The cancer was subsequently treated using conventional treatment,the side-effects of which were successfully dealt with using homeopathy. Thepatient recovered, with no further complaint. How does one end up withcausality ‘Almost certain’ for homeopathy in a clear case were homeopathy wasinstrumental in providing cure?


Another striking example is a case of DRESS(Drug Rash with Eosinophilia and Systemic Symptoms) presented by Bernez etal.[10]. In this case, a homeopathic sleeping pill was taken on two occasionswithout any AE (4 months and 3 weeks before DRESS occurred). The originalauthors (a team of dermatologists at the University of Tours, France) statevery clearly in their conclusions that they do not believe homeopathy wascausative in this case. Yet Posadzki et al. report the causality caused by homeopathyas ‘Certain’.


Such instances of significant divergence betweenthe conclusions of the original authors as published in their case reports andPosadzki et al.'s reporting of them, cast a heavy shadow on the scientificvalidity of the whole review (Data S1).


Differentiating between ordinary standards of homeopathic careand clinical negligence

When assessing the safety of a medicalintervention it is usual to differentiate between non-preventable AEs and thosewhich are preventable with ordinary standards of care [2] i.e. cases ofclinical negligence. Posadzki et al. have failed to make any such distinction.The four deaths they report as being caused by homeopathy involve eithermisprescribing of poisonous substances[8,32] or failure to refer the patientfor essential conventional medical treatment[41,26]. As these cases contravenewhat is considered standard homeopathic care, they should be classified ascases of clinical negligence [3] (Data S1).


Inclusion of non-homeopathic cases

Failure to clearly define ‘homeopathy’ or a‘homeopathic medicinal product’ at the outset of this review has led toinclusion of multiple cases of misprescribing of poisons as well as cases whichare simply not homeopathy at all. For example, a case of AEs caused by Rhustoxicodendron tincture[34] belongs in a review of herbal medicine, nothomeopathy, as does the report of a pharmacist who self-administered a tinctureof the poisonous plant Aconite[22].


Even at a glance, the Posadzki et al. articledoes not inspire confidence in its reporting standards. In their Abstract theystate 38 reports met their eligibility criteria, whereas on the same page inthe results section they state that 35 reports met their eligibility criteria,yet their results tables actually include 37 reports. Two indirect AEs werealso misclassified as direct AEs (Data S1).


The authors have also shown a lack ofconsistency in their decision-making processes regarding inclusion/exclusion ofdata. For example, 1070 of the 1159 cases identified by Posadzki et al. comefrom a single article reporting calls to a toxicological information centre.These comprised calls for information (e.g. following inadvertent ingestion of ahomeopathic remedy) some of which lead to actual AE cases with a maximumseverity of ‘minor’ or ‘mild’[38]. As the article by Zuzak et al.[40] presented2143 similar cases, it is unclear why these were omitted.


Whilst it is beyond the scope of this comment topresent a full re-analysis of the data, our examination of the originalliterature has raised many important issues worthy of further investigatione.g. the need to clearly define homeopathic medicinal products. We thereforerecommend that a new review be carried out using rigorous methods to produce a reliablestudy of the safety of homeopathy.
As clinicians look to systematic reviews onsafety to inform their clinical decision-making, any claims that anintervention carries the risk of causing serious harm or death must be based onresearch carried out to the highest of standards, both in terms of process andaccuracy.
Sadly the quality of this review by Posadzki etal. falls short of this standard by such a large margin, that at best theauthors’ results are unreliable, and at worst we must consider whether thedegree of inaccuracy is such that retraction of this article becomes necessaryto preserve the quality of the peer-reviewed literature.


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