Tag Archives: Cost-effectiveness analysis

Acupuncture is Just as Effective Without Needles

Needles

Acupuncture works, but it appears to work equally well with or without needle penetration. This conclusion was drawn from a treatment study involving cancer patients suffering from nausea during radiotherapy.

In a series of acupuncture studies that involved more than 200 patients who were undergoing radiation treatment, roughly half received traditional acupuncture with needles penetrating the skin in particular points, while the others received simulated acupuncture instead, with a telescopic, blunt placebo needle that merely touched their skin.

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Afterwards, 95 percent of the patients in both groups felt that the treatment had helped relieve nausea, and 67 percent had experienced other positive effects such as improved sleep, brighter mood, and less pain. Both groups felt considerably better than a separate control group that received no acupuncture of any kind.

The acupuncture was performed by physiotherapists two or three times a week during the five week long period of their radiation treatment.

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Mystics and Medicine

Are we being hoodwinked by alternative medicine? ……Two leading scientists examine the evidence. The first of a two-part extract from Trick or Treatment: Alternative Medicine on Trial by Simon Singh and Edzard Ernst:
MIRACLE CURE? Alexander Technique,……… aromatherapy and magnet therapy


Which therapies work and which ones are useless? Which therapies are safe and which ones are dangerous? These are questions that doctors have asked themselves for millennia in relation to all forms of medicine.

And yet it is only comparatively recently that they have developed an approach that allows them to separate the effective from the ineffective, and the safe from the dangerous.

This approach, known as evidence-based medicine, has revolutionised medical practice, transforming it from an industry of charlatans and incompetents into a system of healthcare that can deliver such miracles as transplanting kidneys, removing cataracts, combating childhood diseases, eradicating smallpox and saving millions of lives each year.

Evidence-based medicine is about using the current best evidence — gathered through clinical trials and other scientific investigations — to make medical decisions. Alternative medicine claims to be able to treat the same illnesses and diseases that conventional medicine tries to tackle.

We set out to establish the truth of these claims by using the principles of evidence-based medicine.

Some people will be suspicious of this, perceiving evidence-based medicine as a strategy for allowing the medical establishment to defend its own members and treatment, while excluding outsiders who offer alternative treatments.

In fact, the opposite is often true — evidence-based medicine actually allows outsiders to be heard; it endorses any treatment that turns out to be effective, however strange it may seem.

In the 18th century, for instance, lemon juice as a treatment for scurvy was regarded as implausible but the establishment had to accept it because it was backed up by evidence from trials.

We had no axe to grind — indeed Professor Ernst even practised as a homeopath for many years (as well as receiving treatment as a patient) — and we came to our conclusions based on a fair, thorough and scientific assessment of the evidence.

So what did we find? While some therapies do provide some health benefits (e.g. osteopathy), most have nothing to offer.

Many popular therapies are “effective” only because they are good at eliciting a placebo response; making the patient feel better simply because they believe the treatment will help.

You might feel that as placebos help patients, this alone justifies the use of the therapy. But any treatment that relies on the placebo effect is essentially a bogus treatment. And it’s far from cheap.

If alternative practitioners are making unproven, disproven or vastly exaggerated claims, and if their treatments carry risks, then we are being swindled at the expense of our own good health.

Too many alternative therapists remain uninterested in determining the safety and efficacy of their interventions. These practitioners also fail to see the importance of rigorous clinical trials in establishing proper evidence for or against their treatments — where evidence already exists that treatments are ineffective or unsafe, alternative therapists carry on regardless.

Despite this disturbing situation, the market for alternative treatments is booming, and the public is being misled over and over again, often by misguided therapists; sometimes by exploitative charlatans.

It is time for the tricks to stop, and for the real treatments to take priority. The same scientific standards, evaluation and regulation should be applied to all types of medicine.

If this doesn’t happen, then homeopaths, acupuncturists, chiropractors, herbalists and many other alternative therapists will continue to prey on the most vulnerable — raiding their wallets, offering false hope and even endangering their health.

ALEXANDER TECHNIQUE:-

WHAT IS IT?….. A technique for relearning correct posture and body movements. Alexander teachers guide their clients through exercise sessions using a gentle, hands-on approach. As plenty of repetition is needed, 30 to 100 such sessions are usually required to master the technique, demanding a considerable level of commitment from the client, in terms of both time and money.

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DOES IT WORK? ……Very little research so far has been conducted on the technique. Some promising findings have emerged in terms of improvement of respiratory function, reduction of anxiety, reduction of disability in Parkinson’s disease and improvement of chronic back pain.

However, for none of these conditions is the evidence sufficient to claim that the Alexander technique is effective.

AROMATHERAPY:-

WHAT IS IT?
Plant essences (known as “essential oils”) are used to treat or prevent illnesses or enhance wellbeing. Most commonly, the diluted oil is applied to the skin via a gentle massage, but it can also be added to a bath or diffused in the air.

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Aromatherapists believe that different essential oils have different specific effects. Aromatherapy is advocated for chronic conditions such as anxiety, tension headache and musculoskeletal pain.

DOES IT WORK? Some clinical trials confirm the relaxing effects of aromatherapy massage. However, this is usually short-lived and therefore of debatable therapeutic value. Some essential oils do seem to have specific effects. For instance, tea tree has anti-microbial properties. However, these effects are far less reliable than those of conventional antibiotics. There is no evidence that aromatherapy can treat specific diseases.


CHIROPRACTIC THERAPY:-

WHAT IS IT? Chiropractors use spinal manipulation to realign the spine to restore mobility. Spinal manipulation can be a fairly aggressive technique, which pushes the spinal joint slightly beyond what it is ordinarily capable of achieving, using a technique called high-velocity, low-amplitude thrust — exerting a relatively strong force in order to move the joint at speed, but the extent of the motion needs to be limited to prevent damage to the joint and its surrounding structures.

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Some chiropractors claim to treat everything from digestive disorders to ear infections, others will treat only back problems.

DOES IT WORK?
There is no evidence to suggest that spinal manipulation is effective for anything but back pain and even then conventional approaches (such as regular exercise and ibuprofen) are just as likely to be effective and are cheaper. Neck manipulation has been linked to neurological complications such as strokes — in 1998, a 20-year-old Canadian woman died after neck manipulation caused a blood clot which led to stroke. We would strongly recommend physiotherapy exercises and osteopathy ahead of chiropractic therapy because they are at least effective and much safer. The dangers of chiropractic therapy to children are particularly worrying because a chiropractor would be manipulating an immature spine.


HYPNOTHERAPY:-

WHAT IS IT? The use of hypnosis, a trance-like state, for therapeutic purposes. Hypnotherapists treat a range of chronic conditions, including pain, anxiety, addictions and phobias.

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DOES IT WORK?
Dozens of clinical trials show that hypnotherapy is effective in reducing pain, anxiety and the symptoms of irritable bowel syndrome. However, the evidence is that it’s not effective to help you stop smoking, even though it is frequently promoted in this context.


MAGNET THERAPY:-

WHAT IS IT? The use of magnetic fields from static magnets, which are usually worn on the body, to treat various conditions, most frequently pain. These days rapidly fluctuating magnetic fields are used in conventional medicine in high-tech imaging machines (such as MRI scanners) and for promoting the healing of bone fractures. However, alternative medicine tends to use static magnets, which create a permanent magnetic field, to treat many conditions, mostly to alleviate chronic pain.

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DOES IT WORK? There is no evidence that static magnets offer any medical benefit for pain relief. As they are usually self-administered, there is a danger of missing serious diagnoses and losing valuable time for early treatment of serious diseases.

OSTEOPATHY:-

WHAT IS IT? A manual therapy which focuses on the musculoskeletal system to treat disease. Osteopaths use a range of techniques to mobilise soft tissues, bones and joints. Osteopathy and chiropractic therapy have much in common, but there are also important differences.

Osteopaths tend to use gentler techniques and often employ massage-like treatments. They also place less emphasis on the spine than chiropractors, and they rarely move the vertebral joints beyond their physical range of motion, unlike chiropractors. Therefore osteopathic interventions are less likely to injure.

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In general they treat mainly musculoskeletal problems, but many also claim to treat other conditions such as asthma, ear infection and colic.

DOES IT WORK? There is reasonably good evidence that the osteopathic approach is as effective as conventional treatments for back pain, but there is no good evidence to support the use of osteopathy in nonmusculoskeletal conditions.

People with severe osteoporosis, bone cancer, infections of the bone or bleeding problems should confirm with the osteopath that they will not receive forceful manual treatments.

LOOK BEFORE YOU LEAP:-


*Advice for anyone considering alternative medicine:

*Consult and inform your GP — the treatment might interfere with any ongoing conventional therapies.

*Do not stop your conventional treatment unless your doctor advises that this is sensible.

*Alternative therapies can be expensive, so make sure there is evidence to support the efficacy of a therapy before spending huge sums of money.

*Every treatment carries risks, so make sure the risks are outweighed by the benefits.

Sources: THe Telegraph (Kolkata, India)

Acute Otitis Media in Children

The most common cause of earache in children is acute otitis media, which is caused by infection in the middle children are at risk because eustachian tubes, which connect the middle ear to the throat, are small and become obstructed easily. Acute otitis media is often part of a respiratory tract infection, such as the common cold. The infection causes inflammation that may block one of the eustachian tubes, causing a buildup in the middle ear that may get infected with bacteria.
1.Normal
2.Abnormal……..(1)
The part of the ear that we can see is called the outer ear. It is connected to an external canal, which is then separated from the structures of the middle ear by a thin drum like membrane called the eardrum (tympanic membrane). The middle ear is filled with air and is connected to the back of the nose by a tube like canal called the eustachian tube. The other parts beyond the middle ear are the inner ear (cochlea, semicircular canal) and the auditory nerves (carries messages to the brain).

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Otitis Media refers to an infection of the middle ear that normally follows the flu or a cold. OM can affect people at any age, but it is more common in children under the age 7.

About 1 in 5 children under age 4 has one episode of acute otitis media each year. the condition is more common in children whose parents smoke. It is also common in children of eskimo or native american descent and may run in families, suggesting a genetic factor. The condition is less common in children over the age of 8.

What are the sympotms?
Symptoms usually develop rapidly over several hours. a very young child may have difficulty locating the pain, and the only symptoms may be fever and vomiting. In older children, the symptoms may be more specific and include:

*20-40% of the cases of bacterial infections may have little or no symptoms.
*In infants, there is irritability, poor feeding, or loss of appetite may be the only symptoms for the first few months.
*In cases without bacterial infection, there may be a mild decrease in hearing or a feeling of heaviness in the ear.
*In most cases of acute OM there is:
flu, cold, sinus, throat, allergies, and earaches.
*The bone behind the ear (Mastoid bone) may hurt if it is pressed.
*Decreased hearing
*Fever may or may not be present
*If the eardrum is punctured, fluid may leak out (otorrhea)
*Hearing loss and spread of the infection to other site (brain, facial nerves and mastoid bone) can occur
* Earache.
*Tugging or rubbing the painful ear.
*Temporary impaired hearing in the affected ear.
Left untreated, the eardrum may rupture, relieving the pain but causing a discharge of blood and pus. Recurrent infections in the middle ear may cause chronic secretory otitis media.

Probable Causes:
Conditions such as a Common Cold (caused by a virus), sinuses, throat infections, allergies to tree pollen, mold spores, and mites can irritate the eustachian (E) tube and weaken its normal defenses.

Once the defenses of the eustachian tube is compromised, it is prone to invasion by bacteria, which then climb up to the air filled middle ear chamber and cause an infection. This results in fluid build up, earaches, and other symptoms.

Bacteria responsible for OM are:

Pneumococci (30-35%)
Haemophilus Influenza (20-25%)
Moraxella catarrhalis (10-15%)
Group A streptococci and Staphylococcus species (1-3%)
Up to 30% of cases of OM occur without any Bacterial infections

*Structural abnormalities of the ear or an E-tube present at birth

*Previous history of OM

*Family history of OM, especially in a sibling

*Second hand tobacco smoke

*Day care

*Allergies

*Sinus infections

*Throat infections

*Formula feeding

 

Method of Diagnosis::
Medical history and a physical examination is the first step
There may be facial pain (over the sinuses), nasal (nose) congestion, sore, red throat if allergies exist, or a sinus infection may be present.
There may be enlarged Lymph glands (pea size nodes) in the neck
The mastoid bone may hurt if doctor presses on it.
The doctor will use a special light (otoscope) to look into the ear canal, where he will see the ear drum bulging out (fluid behind it), moving poorly, or have a tear and the middle ear where fluid is leaking into the external canal.

The fluid that may have leaked out can be collected by a sterile cotton swab, and sent to the laboratory so they can identify the cause and type of the bacteria (takes 24-48 hours).

Hearing can be tested by a specialist called an audiologist.
Risk Involvement:
*Males more than females
*Ear trauma or previous ear surgery
Modern Treatment:
* Usually treated on an outpatient basis except for infants under 2 years of age with high fever.
*If not too sick, use Auralgan drops (eases the pain) and Tylenol (pain and fever) by mouth, and observe closely for the first 2-3 days.
*If symptoms persist for more than 48-72 hours, or the patient is sick, consider antibiotics.
*Antibiotics such as Amoxicillin are given by mouth for up to 10 days (or until the bacteria is identified).
*If there are 3 or more OM’s in 6 months, or 4 or more in one year, then antibiotics may be needed for up to 6 months.
*In cases where there is persistent fluid (Effusion) in the middle ear without bacteria (consider Allergy), antibiotics do not help, and Antihistamines (Claritin) or decongestants such as Entex can be tried.
*In allergic OM, where medications do not help, one may consider consulting with an allergy and Immunology doctor.
*In cases where middle ear effusion is present for more than 4 months in both ears, or more than 6 months in one ear, or, if hearing is affected (greater than 25 decibels), surgery may need to be done.
*Recurrent bacterial OM (more than 2-3) while on antibiotics may also benefit from surgery.
*An ENT (ears, nose, throat) doctor will perform all necessary surgeries.
*Surgeries include drainage of the middle ear fluid via a tiny tube (tympanostomy tube).
*The tube may be placed for days, weeks, months, or in some cases, permanently.
*A good diet that is full of vegetables, fruits, fish, and low in animal products (beef, pork, etc.) and fats may help to prevent future infections.
*Try breast-feeding your baby
*Stop smoking, especially around your children and animals.
What might be done?
You should consult you child’s doctor if liquid is discharged from the ear or if the earache last more than a few hours. he or she will examine your child’s ears and may blow air into the affected ear using a special instrument to check that the eardrum is moving normally. Acute otitis media can clear up without treatment; however, the doctor will probably prescribe antibiotics if he or she suspects that a bacterial infection is present. to relieve discomfort, acetaminophen may be recommended. After a few days, your doctor will reexamine you child.

Symptoms usually clear up in a few days with appropriate treatment. a ruptured eardrum should heal within a few weeks. In some children, hearing is affected for more than 3 months until the fluid in the ear disappears.

Research: Otitis Media

Acute Otitis Media in Children — Current Concepts

Acute Otitis Media treatment & Prevention

Healing Otitis Media Through Homeopathy

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.

Reources:

http://www.ecureme.com/emyhealth/data/Serous_Otitis_Media.asp
http://www.charak.com/DiseasePage.asp?thx=1&id=339