Tuesday, December 27, 2016

Acne Vulgaris BMJ

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Expert Author Pradeep Chadha
Recent Trends
Four out of ten Americans were using alternative-medicine and not telling their doctors(1). Chinese herbal medicine helped people with Irritable Bowel Syndrome(2). A ketogenic diet decreased intractable seizures in children(3) But according to other researches, Echinacea extracts did not prevent upper respiratory infections(4) and chiropractic manipulations did not improve episodic-tension-type headaches.(5)
These researches may have had their own flaws. But according to another article published in British Journal of Medicine, double standards exist in judging traditional and alternative medicine.6 In a conference in integrated medicine in London, Dr. Iain Chalmers said, "critics of complementary medicine seemed to operate a double standard". It is thought that 60% of orthodox treatments have not been scientifically proved.(6)
In 1999, a series of articles was published in the British Medical Journal (BMJ) under the title-ABC of Complementary Medicine. Catherine Zollman and Andrew Vickers authored these articles. In an article in this series published in BMJ of 11 September 1999, the authors defined Complementary Medicine as " ...a group of therapeutic diagnostic disciplines that exist largely outside the institutions where conventional health care is taught and provided. Complementary medicine is an increasing feature of healthcare practice, but considerable confusion remains about what exactly it is and what position the disciplines included under this term should hold in relation to conventional medicine".(7)
According to another article published in BMJ of 25 September 1999, an UK survey of use of Complementary medicine estimated that in1993, 33% of the population had used some form of Complementary medicine. 55-65% of those who consulted complementary practitioners were female, a similar proportion to users of conventional healthcare. The other highlights of this survey were:
· The highest users were those aged 35-60 years.
· Children made up a relatively small proportion of users of complementary medicine.
· Users of complementary medicine tended to be in higher socio-economic groups and had higher levels of education than users of conventional care.
More people used complementary medicine in the south of England than in Wales, Scotland and the north of England.But evidence suggested that this reflected access to availability of complementary practitioners rather than any fundamental regional differences in public attitude or interest.(8) 
On acupuncture, the authors wrote: - "There is good research evidence that acupuncture has effects greater than placebo. Randomised trials have found that true acupuncture is more effective in relieving pain than 'sham' technique such as inserting needles away from true points." "Studies showing that acupuncture can affect anaesthetised animals provides further evidence that its effects probably cannot be explained purely in psychological terms."(9)

"The best known evidence about a herbal product concerns St. John's wort (Hypericum perforatum) for treating mild to moderate depression. A systematic review of 23 randomised controlled trials found the herb to be significantly superior to placebo and therapeutically equivalent to, but with fewer side-effects than antidepressants such as amitryptyline." "Eighty seven adults and children refractory to conventional first and second line treatment were randomised to a crossover study that compared a preparation of about 10 Chinese herbs with a placebo consisting of herbs thought to be ineffective for eczema. Highly significant reductions in eczema scores were associated with active treatment but not with placebo. At long term follow-up, over half of the adults (12/21) and over 75% of children (18/23) who continued had a greater than 90% reduction in eczema scores".(10)
Studies on Homeopathy
An evidence of the efficacy of homeopathic medications was published in BMJ.
The paper was authored by Morag A Taylor and associates. It concluded that homeopathic dilutions differ from placebo. This study was done on fifty patients suffering with perennial allergic rhinitis. The results showed significant nasal airflow improvement compared with the placebo group(11). An earlier paper authored by Andrew Vickers and Catherine Zollman in BMJ quoted an article in Lancet in favour of homoeopathy. The authors of this article in Lancet were quoted as: - " the results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homoeopathy are due to placebo." "Laboratory studies have reported biological effects of homeopathy medicines on animals, plants and cells, some at ultramolecular dilutions."(12)
Mind-Body Connection in Modern Medicine
On another note, there are many researches published in journals of modern medicine that corroborate mind-body connection. Role of emotional distress and the origin of cardiac illnesses are an accepted fact in modern medicine. In a recent research conducted by Dr. Ketterer and colleagues from Henry Ford Health Sciences Center in Detroit, it was recommended that "chest pain should be considered a marker of emotional distress." "Reducing emotional distress may benefit the (healthcare) system as well as the patient by spontaneously decreasing emergency room visits, diagnostic tests and hospital admissions."(13)
A study done in the Cancer Institute of New Jersey by Dr. Pandya and associates concluded that conventional mind-body therapy has been poorer with valuable non-invasive way to manage coronary disease. Yoga practice is valuable in coronary disease by improving resistance to stress.(14)
People with diabetes are twice as likely as non-diabetics to suffer from depression, according to an analysis of 25 years of data authored by Dr. Patrick J. Lustman of Washington University School of Medicine in St. Louis. "Two of every three cases of depression in diabetes go untreated by primary care physicians".(15) He recommends that both conditions need to be treated together.
In a study published in Digestive Diseases and Science authored by Dr. Svein Blomhoff of National Hospital, Oslo, it was demonstrated that there is a clear connection between mind and body. Emotional responses have an impact on intestinal reactivity in-patients with irritable bowel syndrome (IBS) and in normal controls.
"The close interaction among mind, brain and gut" indicates that "gut motility may be a dynamic indication of level of stress or emotional state."(16)
Non-Physical Treatments
Psychotherapy is helpful for patients with intractable dyspepsia. One study was done by Dr. Elspeth Gutherei of the Manchester Royal Infirmary and was published in Gastroenterology in the year 2000.(17) In the same issue, Dr. David H. Alpers of Washington University School of Medicine, St. Louis, Missouri, advised gastroenterologists to pay attention to psychological diagnostic and therapeutic tools and to learn to apply them to patients in functional bowel disorders.
Results from some controlled trials of "distant healing" show that such forms are positively effective. A study by Dr. John A Astin and associates at Kernon Hospital Mansion, in Baltimore Maryland, concluded this finding. 23 trials including five trials of prayer, 11 studies of non-contact therapeutic touch and seven trials of mental healing and spiritual healing were studied.(18)
Conclusion
There is ample evidence in modern medical literature that suggests that there are links between physical illnesses and emotional and mental distress. Research evidence shows that there is learning involved in "observation." Every "scientific" discovery starts with "observation." The observation is then followed by "scientific research."
Complementary therapies are following the same pattern of knowledge as modern medicine has followed. Practitioners can make themselves more aware of the scientific basis of medicine by reading and researching on modern medicine. Complementary medicine will need to become more scientific sooner rather than later.
References:
1. Journal of the American Medical Association (1998) 280:1549-640
2. Journal of the American Medical Association (1998) 280:1585-90
3. Archives of Neurology (1998)55: 1433-8
4. Archives of Family Medicine (1998) 7: 541-5
5. Journal of the American Medical Association (1998) 280:1576-9
6. British Medical Journal (1998) 316:1694
7. British Medical Journal (1999) 319:693-696
8. British Medical Journal (1999) 319: 836-838
9. British Medical Journal (1999) 319:973-976
10 British Medical Journal (1999) 319: 1050-1053
11. British Medical Journal (2000) 321: 471-476
12. British Medical Journal (1999) 319: 1115-1118
13. Journal of Behavioural Medicine (2000) 23:437-44
14. Comparative Therapy (1999) 25(5): 283-93
15. Diabetes Care (2001) 24: 1069-1078
16. Digestive Diseases and Sciences (2000) 45: 1153-1165
17. Gastroenterology (2000) 119: 661-669, 869-871
18. Annals of Internal Medicine (2000) 132: 903-910
Pradeep K Chadha is a psychiatrist who specialises in helping patients with meditation and imagery using little or no medication. He is the author of The Stress Barrier-Nature's Way To Overcoming Stress published by Blackhall Publishing, Dublin. His second book-The Road To A Happy Life- is being published this year by Raider Publishing in the UK, USA and Canada.He is based in Dublin, Ireland.His website address is :http://www.drpkchadha.com

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