Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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The human element
- Arun Nanivadekar (5 July 2008)
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A bad report?
- Peter O'Loughlin (6 July 2008)
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Omissions & Omissions!
- John Boyce (7 July 2008)
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Re: Omissions & Omissions!
- Peter O'Loughlin (9 July 2008)
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Arun Nanivadekar, Medical Research Consultant C-2, Flushel Apts., 21 Road, bandra (W), Mumbai 400050, India
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Mr Colquhoun's letter makes me aware afresh of the well entrench vested interests that foil all efforts for the proper evaluation of alternative/complementary systems of medicine. In many countries, such as India, there is an established, non-price controlled, and lucrative market for such therapies. The beneficiaries of such enterprises naturally are wary of any evidence that may question the efficacy or safety of their treatments. It is even possible that medical practitioners and policy makers have financial stakes in such enterprises. Who then would be willing to upset the applecart and incur the ire of all (except the patients)? As I have commented in my book[1], "If we believe that undiscovered gems of therapeutic value are lying hidden among the alternative medicines (herbal or any ohter), we should encourage their discovery and development. ... By doing so we would render the best service to both alternative and modern medicines and to ourselves." Arun Nanivadekar, MD MSc [1] Nanivadekar A. Understanding The Medicines We Take. New Delhi: Oxford University Press, 2000; 47-48. Competing interests: I am a medical research consultant to some hospitals and pharmaceutical companies in India. |
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Peter O'Loughlin, Principal Beckenham BR3 3AT
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In his derisory views of complementary medicine, it is notable that Professor Coloqhoun makes no mention of the historical, and dubious practices of the pharmaceutical industry in supressing, or attempting to supress, then subsequently attemtpting to deny, the evidence of the damage inflicted by drugs such as Barbituates and Benzodiazepines, which apart from other horrendous side effects, proved to be highly addictive.(1,2&3) A further omission is the Cochrane review on Valerian v placebo,v diazepam.(4) whilst it is true that further studies are needed, the fact that a herb can not only be as equally affective as an addictive substance, it has the distinct advantages of more benign side effects, and is certainly not addictive. As such, it is a good exmaple of complementery medicine. References: 1 Isabell, H. et al Chronic Barbituate Intoxication: An experimental. study: Archives of Neurology & Psychiatry, 64. 1 July 1950. 2. Allen, S. Oswald, I: Anxiety and sleep and Fosazepam; British Journal of Clincial Pharmacology. 1976,3 165-8. 3. Allugulander C: Dependence on sedative and hypnotic drugs; Acta Psychiatry Scand, 1978, Spllement 270. 4 Miyasaka LS, Atallah AN, Soares BGO. Valerian for anxiety disorders. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004515. DOI: 10.1002/14651858.CD004515.pub2 Competing interests: Drug and alcohol addiction recovery. |
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John Boyce, Public Health Practitioner Edenhall Hospital, East Lothian, EH21 7TZ
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Mr O'Loughlin's criticism of Professor Colqhoun for omitting the Cochrane Valerian review is misleading. While he admits that more research is needed he fails to draw any attention to the authors’ conclusion that: “… there is insufficient evidence to draw any conclusions about the efficacy or safety of valerian compared with placebo or diazepam for anxiety disorders.” 1 1. Miyasaka LS, Atallah AN, Soares BGO. Valerian for anxiety disorders. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004515. DOI: 10.1002/14651858.CD004515.pub2 (available online at: http://www.cochrane.org/reviews/en/ab004515.html. Accessed 7th July) Competing interests: None declared |
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Peter O'Loughlin, Principal Beckenham BR3 3AT
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John Boyce (BMJ rapid responses 7 July) is correct in drawing attention to my sins of omission. Equally his extract from the authors’ conclusion in the review in question, omits a number of salient points from the ‘Main Results’. For the sake of clarity the verbatim is reproduced below: ‘One RCT involving 36 patients with generalised anxiety disorder was eligible for inclusion. This was a 4 week pilot study of valerian, diazepam and placebo. There were no significant differences between the valerian and placebo groups in HAM-A total scores, or in somatic and psychic factor scores. Similarly, there were no significant differences in HAM-A scores between the valerian and diazepam groups, although based on STAI-Trait scores, significantly greater symptom improvement was indicated in the diazepam group. There were no significant differences between the three groups in the number of patients reporting side effects or in dropout rates’. (1) The main thrust of my letter was intended to show that based on those results, there were no significant differences on the Hamilton Anxiety Rating scale between Valerian and Diazepam. However I should have pointed out that the STAI-Trait scores revealed a distinct advantage for diazepam. I tender my apologies for any unintentional‘misleading'. It also has to be acknowledged that in this particular trial, the otherwise well documented, referenced evidence, of the side effects of diazepam, including their addictive nature which I referred to in my earlier letter were not apparent. However, I stand by my concerns of their existence. In further support of those views I would refer to the article in the Irish Medical Times (2) citing the 2002 Bradley report, which made clear that the prescribing of of benzodiazepine should be considerably reduced. It is therefore distressing to learn from the same article that the opposite has happened, with a 42% increase in use. The same article points out: “that patients continue to use these drugs, long after they cease to have any therapeutic effect, to avoid withdrawal symptoms” (a significant indication that dependency has set in) “which can include a condition similar to delirium tremens” Equally, if not more disturbing are the quoted views of an unnamed ‘senior lecturer’: “Most experts regard this as crazy because the drugs have no therapeutic value after three to four weeks. After this, the pills are merely feeding an addiction,” This writer has no quarrel with the use of pharmacotherapy as a valuable, and in some cases, indispensable aid to recovery from alcohol and drug addiction. He does however have considerable reservations about what appears to be indiscriminate prescribing of any substance, which it itself, is capable of inducing further addiction.. References 1 Miyasaka LS, Atallah AN, Soares BGO. Valerian for anxiety disorders. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004515. DOI: 10.1002/14651858.CD004515.pub2 2 Prescribing Drug Abuse: Culliton, G. Irish Medical Times; posted in ‘Public Health’ 27 June 2008. www.imt.ie/news/public_health/ http://www.imt.ie/news/2008/06/prescribing_drug_abuse.html Competing interests: Alcohol and Drug Addiction Recovery. |
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