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英國科學與技術報告 UK Science & Technology report

admin 發表於 2015-12-15 17:32:48 | 顯示全部樓層 |閱讀模式
英國科學與技術報告 UK Science& Technology report
It is often reported that there is no evidence homeopathy works or that the current evidence base shows homeopathy is no better than placebo. Neither statement is correct.

Such misconceptions stem largely from the House of Commons Science and Technology Committee ‘Evidence Check 2: Homeopathy’ report,produced by a committee of 14 Members of Parliament (MPs)1. This report concludedthat homeopathy works no better than placebo and that there should be no more research carried out into homeopathy.
此等誤解主要源自於下議院科學技術委員會的「實證檢查2:順勢療法」報告,由14名議會成員 (MP)1組成的委員會撰寫。該報告的結論是:順勢療法的效用不如安慰劑,因此不應該就順勢療法進行更多研究。

‘S & T’ reportkey points科學與技術」報告重點

  • The report is not  a scientific document and therefore should not be used as evidence by decision-makers
  • It is not just  homeopaths who say it is flawed – the report has been widely criticised by people outside the homeopathic profession
  • The committee excluded all evidence other than 5 systematic reviews and based their conclusions on only 1 of these studies
  • The report does not represent the view of UK Government – the Department of Health dismissed the report
1.   該報告並不屬於科學文件,因此,決策者不應該將之作為證據。
2.   不僅有順勢療法醫生指出這報告是錯誤的—— 該報告亦廣泛遭受非順勢療法專業人士之民眾批評。
3.   除了5份系統評審 (systematicreview),該委員會將所有其他證據完全排除在外,他們只根據當中的一份研究來下結論。
4.   該報告並不代表英國政府之觀點——英國國家衛生署已駁回該報告。

Reliability of thereport 報告的可靠性
As this document is widely quoted, its reliability needs to be considered. Although often referred to as a ‘comprehensive review’ of the evidence, the ‘Evidence Check 2 report’ is not a scientific document. No systematic scientific method was applied, it was not carried out by expert academics in the field and the choice of evidence included showed a disturbing bias – both in terms of written submissions and the choice of witnesses permitted to give oral evidence.

Such fundamental flaws have been widely acknowledged by those outside the homeopathic profession:

  • 4 MPs voted on the report: 3 voted to ratify the report and 1 MP (Ian Stewart MP) abstained, dissenting from the report because he was concerned by the “balance of witnesses”
  • 70 MPs expressed their concern by signing an Early Day Motion (EDM 908)2
  • An independent critique by Earl Baldwin of Bewdley concluded that the report was “an unreliable source of evidence about homeopathy”.3 Earl Baldwin’s opinion is of particular interest as he served on the House of Lords Science and Technology Sub-Committee that inquired into complementary and alternative medicine in 1999-2000 and so was familiar  both with correct S & T Committee procedures and the topic in question.
  • 4 議會成員就報告投票:3 名投贊成票以認可此報告,1議會成員伊恩•斯圖爾特 (Ian Stewart MP))投下棄權票,他對報告持反對意見,因為他考慮到「人證平衡」問題。
  • 70 議會成員提出第908號早期動議 (Early Day Motion, EDM908)2,以表示他們對此報告之關注。
  • 比尤德利 (Bewdley) 的鮑德溫伯爵 (Earl Baldwin) 發表了一份獨立的評論文章,結論指出該報告是「一份有關順勢療法的不可靠證據來源」3。鮑德溫伯爵的意見特別令人感興趣,因為他曾於 1999-2000 年擔任上議院「科學與技術小組委員會」成員,當年就正正負責探究輔助和替代醫學(包括順勢療法),因此,他無論對於科學與技術委員會之正確程序,或是討論中的話題,都十分熟悉。

These and other problems have been reported by adedicated website: http://www.homeopathyevidencecheck.org/

What evidence doesthe report cover?此報告涵蓋了哪些證據?
Reliability aside, a second pertinent issue is that the EvidenceCheck 2 report only considered efficacy not effectiveness i.e. they only looked at trials testing whether homeopathy works under tightly controlled, artificial experimental conditions, not studies testing whether it works on ‘real patients’ under real world clinical conditions.
      撇開可靠性不說,第二個相關問題是:「實證檢查報告2」只考慮到功效(efficacy)並不是有效性  (effectiveness),也就是說,他們只關注順勢療法在嚴謹的條件監控下、人為的實驗狀況下試驗順勢療法是否有用,沒有任何研究是在真實世界臨床情況下進行,測試順勢療法在「真實病人」身上是否有效。

They therefore excluded all observational studies (even highquality controlled studies) and only considered the five main comprehensive meta-analyses of randomised controlled trials (RCTs).4,5,6,7,8 From this evidence thefour meta-analyses which found in favour of homeopathy were excluded,4,5,6,7 based on the testimony of Prof Edzard Ernst that, in his opinion, they were unreliable. This left only one study to inform the report’s conclusions – the comprehensive comparative meta-analysis known as The Lancet study by Shang et al. published in 2005.8
       因此,他們排除了所有觀察性研究(甚至是高質素的對照研究),並只考慮五份主要隨機對照試驗 (RCT)4,5,6,7,8的綜合性薈萃分析。而且從這些證據中,排除掉四個有利於順勢療法的薈萃分析4,5,6,7,根據埃得扎德教授 (Prof. Edzard Ernst) 的陳述,依他個人的看法,它們並不可靠。於是,最後只剩下一份研究,作為報告結論的根據——那就是2005年由尚文(Shang) 等人發表於柳葉刀的綜合比較薈萃分析——柳葉刀研究  (The Lancet study)。8

Reliability of the Lancet study
Considering that this single paper is the only major study everto conclude that homeopathy is no more than a placebo effect, its role in the debate cannot be overstated, so one again quality and reliability are paramount.

Unfortunately multiple concerns have been raised about the Shang et al. study, particularly the fact that it’s conclusions were based on only 8 trials out of the 110 available at the time and that itfails a sensitivity analysis9 i.e. if you remove justone of the 8 trials they used in the analysis, the result is reversed, showing that homeopathy works beyond placebo. Furthermore not one of those 8 trials used involves individualised homeopathic treatment – the form of homeopathy considered to be ‘usual care’.

Reliability of the analysis is not the only problem with theShang paper. As we take a fresh look at the evidence in 2014, we also need to consider how well this study reflects the entirety of today’s evidence base. A recent literature search by Mathie et al.10 has identified 151placebo-controlled randomised trials which would have met the inclusion criteria for Shang’s review – 41 more than identified in 2005. This demonstrates the extent to which this 8 year old review, which now covers only73% of the eligible trials, has become outdated.
  關於尚文的論文,分析的可信度並不是唯一問題。當我們重新審視2014年已存在的證據,同時我們更需要考慮,該研究是否能夠好好反映現今證據資料庫的整體面貌。默菲  (Mathie) 等人10於2013年進行的文獻檢索,已識別出有151份隨機安慰劑對照試驗,都能符合尚文 (Shang) 審查的採納準則——比2005年時多了41份。這說明了在某程度上,這項為期8年之久的審查,如今只能涵蓋73%符合條件的試驗,因此已經是過時的。

A state of confusion混淆狀態
The chairman, Phil Wills, made the following statement duringthe committee hearings:
主席菲爾.威爾斯 (Phil Wills)在委員會聽證會時,發表聲明如下:

…….. there seems to be a little confusion about the nature ofthe work that we are doing, this is not an inquiry into whether homeopathy works or not. […….] I want to make that absolutely clear. I wonder if we can therefore start with you, Minister. Does the Government have any credible evidence that homeopathy works beyond the placebo effect? 11
……對於我們正在進行的工作性質,這裡似乎有點混淆,這並不是一個打聽順勢療法是否有效的途徑。[......] 我想要把它弄得絕對清楚。因此,署長,我們想要由您開始。政府是否擁有任何可靠證據,證明順勢療法超越安慰劑的效用?11

The final report then concluded that homeopathy works no better than placebo.

UK Governmentposition英國政府立場
The government response to the Science & Technology Committee’s report was published by the Department of Health in July 201012.

The government refused to ban homeopathic products and identified homeopathy as a recognised and widely used system of medicine acrossthe EU. The response emphasised patient choice as a key reason for continuingto fund homeopathy on the NHS.

政府拒絕禁止順勢療法產品,而且認定順勢療法為整個歐盟中備受認可、以及被廣泛使用的醫藥系統。該回應強調,病人的選擇是一個重要因素,因此英國國民保健服務  (NHS) 會繼續資助順勢療法。

Reference :

  • Evidence Check 2:     Homeopathy, Report by the House of Commons Science and Technology     Committee, February 2010 [link]
  • UK Parliament     Early Day Motion 908 [link]
  • Earl Baldwin of     Bewdley, June 2010: Observations on the report Evidence Check 2:     Homeopathy by the House of  Commons Science and Technology Committee,     February 2010 [link]
  • Kleijnen, J.,     Knipschild, P. & ter Riet, G. Trials of homeopathy. BMJ 302, 960     (1991). [Pubmed]
  • Linde, K. et al.     Are the clinical effects of homeopathy placebo effects? A meta-analysis of     placebo-controlled trials. Lancet 350, 834–843 (1997). [Pubmed]
  • Linde, K. et al.     Impact of study quality on outcome in placebo-controlled trials of     homeopathy. J. Clin. Epidemiol. 52, 631–636 (1999). [Pubmed]
  • Cucherat, M.,     Haugh, M. C., Gooch, M. & Boissel, J. P. Evidence of clinical efficacy     of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeopathic     Medicines Research Advisory Group. Eur. J. Clin. Pharmacol. 56, 27–33     (2000). [Pubmed]
  • Shang A,     Huwiler-Muntener K, Nartey L, et al. Are the clinical effects of     homoeopathy placebo effects? Comparative study of placebo-controlled     trials of homoeopathy and allopathy. Lancet, 2005; 366: 726–32 [Pubmed]
  • Lüdtke, R. &     Rutten, A. L. B. The conclusions on the effectiveness of homeopathy highly     depend on the set of analyzed trials. J. Clin. Epidemiol. 61, 1197–1204     (2008). [Pubmed]
  • Mathie, R. T. et     al. Randomised controlled trials of homeopathy in humans: characterising     the research journal literature for systematic review. Homeopat. J. Fac.     Homeopat. 102, 3–24 (2013). [Pubmed]
  • Science &     Technology Committee Evidence Check 2: Homeopathy, Session 2, Mon 30th     November, Q174
  • The UK government     response to the Science & Technology Committee’s report [Link]

極地寒 發表於 2015-12-21 23:45:09 | 顯示全部樓層
edtps2010 發表於 2016-5-16 19:39:52 來自手機 | 顯示全部樓層
如果用這樣片面的事事來證明順勢療法的有效程度,咁西醫醫學報告是否每個報告都成功? 如果它們有一個不成功,我們便拿著來大事報告,證明西醫醫療是無效的,那樣可以嗎? 中肯嗎? 只怕這樣會被别人說成是刻意攻擊西醫呢! 而這個報告又怎會不是刻意攻擊順勢療法呢?
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