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      Repositioning Individualized Homeopathy as a Psychotherapeutic Technique With Resolvable Ethical Dilemmas

      article-commentary
      , ND, MSc, MA 1
      Journal of Evidence-based Integrative Medicine
      SAGE Publications
      homeopathic, psychotherapy, placebo

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          Abstract

          The author puts forth the argument that the complementary and alternative medicine community should endorse specific aspects of the entire individualized homeopathic process, including its unique holistic consultation process, having dedicated lengths of time to enumerate the complete illness context, and the prescribing of homeopathic remedies, to reposition this modality as a psychotherapeutic technique. Moreover, placebo effects derived from homeopathic remedies could be used to further exploit favorable therapeutic effects that have accrued from the entirety of the homeopathic consultation process. The overall aim of this bold shift is to sustain the clinical practice of homeopathy from an ethical and clinically responsible (and plausible) framework that is properly evidence-informed.

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          Most cited references21

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          Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome

          Background Placebo treatment can significantly influence subjective symptoms. However, it is widely believed that response to placebo requires concealment or deception. We tested whether open-label placebo (non-deceptive and non-concealed administration) is superior to a no-treatment control with matched patient-provider interactions in the treatment of irritable bowel syndrome (IBS). Methods Two-group, randomized, controlled three week trial (August 2009-April 2010) conducted at a single academic center, involving 80 primarily female (70%) patients, mean age 47±18 with IBS diagnosed by Rome III criteria and with a score ≥150 on the IBS Symptom Severity Scale (IBS-SSS). Patients were randomized to either open-label placebo pills presented as “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes” or no-treatment controls with the same quality of interaction with providers. The primary outcome was IBS Global Improvement Scale (IBS-GIS). Secondary measures were IBS Symptom Severity Scale (IBS-SSS), IBS Adequate Relief (IBS-AR) and IBS Quality of Life (IBS-QoL). Findings Open-label placebo produced significantly higher mean (±SD) global improvement scores (IBS-GIS) at both 11-day midpoint (5.2±1.0 vs. 4.0±1.1, p<.001) and at 21-day endpoint (5.0±1.5 vs. 3.9±1.3, p = .002). Significant results were also observed at both time points for reduced symptom severity (IBS-SSS, p = .008 and p = .03) and adequate relief (IBS-AR, p = .02 and p = .03); and a trend favoring open-label placebo was observed for quality of life (IBS-QoL) at the 21-day endpoint (p = .08). Conclusion Placebos administered without deception may be an effective treatment for IBS. Further research is warranted in IBS, and perhaps other conditions, to elucidate whether physicians can benefit patients using placebos consistent with informed consent. Trial Registration ClinicalTrials.gov NCT01010191
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            Psychological interventions for rheumatoid arthritis: a meta-analysis of randomized controlled trials.

            To carry out a systematic review of the literature examining the efficacy of psychological interventions (e.g., relaxation, biofeedback, cognitive-behavioral therapy) in the treatment of rheumatoid arthritis (RA). Studies that met the following criteria were included: random assignment, wait-list or usual care control condition; publication in peer-reviewed journals; treatment that included some psychological component beyond simply providing education information; and separate data provided for patients with RA if subjects with conditions other than RA were included. Two investigators independently extracted data on study design, sample size and characteristics, type of intervention, type of control, direction and nature of the outcome(s). Twenty-five trials met the inclusion criteria. Methodologic quality was assessed, and effect sizes were calculated for 6 outcomes. Significant pooled effect sizes were found postintervention for pain (0.22), functional disability (0.27), psychological status (0.15), coping (0.46), and self efficacy (0.35). At followup (averaging 8.5 months), significant pooled effect sizes were observed for tender joints (0.33), psychological status (0.30), and coping (0.52). No clear or consistent patterns emerged when effect sizes for different types of treatment and control conditions were compared, or when higher quality trials were compared to lower quality ones. Findings do, however, suggest that these psychological interventions may be more effective for patients who have had the illness for shorter duration. Despite some methodologic flaws in the literature, psychological interventions may be important adjunctive therapies in the medical management of RA.
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              Why do open-label placebos work? A randomized controlled trial of an open-label placebo induction with and without extended information about the placebo effect in allergic rhinitis

              Background Several studies demonstrated that placebo treatment may have a significant impact on many different symptoms. While in the traditional view concealment of the placebo is essential, recent studies report intriguing evidence that placebos may work even without deception. For example, it has been demonstrated that open-label placebos can improve symptoms in allergic rhinitis. However, the mechanisms of how placebos without concealment work remain unknown. Trial design In order to examine expectancy effects we conducted a randomized controlled trial (N = 46), in which patients with allergic symptoms received either placebos without deception or no pills at all. In half of those patients we induced positive expectations about the placebo effect. After two weeks we tested whether symptoms and quality of life had changed. Results Results revealed that open-label placebos improved allergic symptoms more than the control group. Inducing positive expectations had no effects on the improvement of allergic symptoms (the primary and more objective outcome), but on mental sum scores of the quality of life questionnaire. Conclusions Placebos without deception can improve symptoms in allergic rhinitis. Positive expectations do not contribute to the efficacy of open-label placebos, but seem to have an effect on more global and subjective well-being (mental or emotional quality of life). Clinical trial registration number German Clinical Trials Register, DRKS00012303
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                Author and article information

                Journal
                J Evid Based Integr Med
                J Evid Based Integr Med
                CHP
                spchp
                Journal of Evidence-based Integrative Medicine
                SAGE Publications (Sage CA: Los Angeles, CA )
                2515-690X
                27 August 2018
                2018
                : 23
                : 2515690X18794379
                Affiliations
                [1 ]Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
                Author notes
                [*]Jonathan E. Prousky, ND, MSc, MA, Canadian College of Naturopathic Medicine, 1255 Sheppard Avenue East, Toronto, Ontario, Canada M2K 1E2. Email: jprousky@ 123456ccnm.edu
                Article
                10.1177_2515690X18794379
                10.1177/2515690X18794379
                6111390
                30146897
                9fffa137-c824-4ae6-9b15-68b5a5ad60f7
                © The Author(s) 2018

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 20 July 2018
                : 23 July 2018
                Categories
                Commentary
                Custom metadata
                January-December 2018

                homeopathic,psychotherapy,placebo
                homeopathic, psychotherapy, placebo

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