顺势疗法:不接受没有证据和与基础科学相矛盾的药物

R. M. Almeida
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These limitations have also been discussed by many other authors (e.g. as summarized in), and, as I mentioned, were even admitted by the authors of one of that reviews, who substantially reconsidered their conclusions. Concerning the third review, I reported the results of the best available evidence the review could provide. It surprises me that someone could disagree with this approach. 2) Dantas and Fisher erroneously attributed to me the statement that the bias in the Linde et al review was “difficult to estimate”. This statement, inside quotation marks in my paper, actually comes directly from the review. Also, the sensitivity analysis Dantas and Fisher mention does not consider the composite effect of quality bias, an important point that I discussed at length (in this respect, the reader, as well as Dantas and Fisher, should find interesting the Table 1 in the very didactic Ernst review, or the discussion in). 3) My citation of the Linde et al review (“...we found little evidence of effectiveness of any single homeopathic approach on any single clinical condition”) is verbatim. 4) In my paper, I cited literature reviews and a few studies that I considered illustrative of the negative results of homeopathy. Dantas and Fisher took issue with that, alluding to “systematic reviews and metaanalysis in this area that are positive” (rhinitis, post-operative ileus, arthritis). However, their first reference is a “meta-analysis” with three studies by a same author, which was later contradicted by a study with hundreds of patients (one of the studies I mentioned). The second concerned six studies on post-operative ileus, in which, one more time, a negative result appeared in the largest and best designed study (commissioned by the French government to validate two low-quality studies also included in the review). This review also yielded a negative result for studies above 12C, an information included in my paper, since, as I also discussed, it reveals something about why sometimes a positive result is found for homeopathy. Another reference is a sub-set of six studies from the discussed Linde et al paper, and the other one, with four short-term studies on arthritis, stated that a firm conclusion could not be made, despite a positive result. In fact, the authors of this last review thus summarized their conclusions, in a later publication: “no clear trend in favor of homeopathy”. This adds nothing of substance to my review. 5) Dantas and Fisher allude to “other” inaccuracies that they would not address. This is not a proper way to engage in scientific debate, and all I am left to say is that it sounds like a convenient excuse for avoiding other very damaging points I made, such as the mentioned quality bias in homeopathic studies, contamination problems, the pathetic performance of homeopathy in “provings” and the bizarre physical hypotheses that disguise as “research” among homeopaths. 6) Dantas and Fisher state that I “mock” the possibility of a homeopathic structural effect in water. That they could consider a description of this research “mocking” only comes to show the sad state of affairs in it. As I said, the research history of water physical properties that could be useful for homeopathy is long and unfortunate: water memory, electric ice crystals, water crystals, water clustering, NMR analysis of homeopathic preparations, and the most recent of these, thermoluminescence analysis for homeopathy. Unfortunately, the result of such endeavor has always been the same: studies are later shown to be nonreplicable, the product of contamination, error or simply forthright fraud; and do not add anything to our scientific and medical knowledge. But homeopaths choose to forget past fail-","PeriodicalId":76453,"journal":{"name":"Revista do Hospital das Clinicas","volume":"59 1","pages":"155-156"},"PeriodicalIF":0.0000,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":"{\"title\":\"Homeopathy: do not accept as medicine what has no evidence and contradicts basic science\",\"authors\":\"R. M. Almeida\",\"doi\":\"10.1590/S0041-87812004000300012\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Dantas and Fisher state that my review is “selective” and “biased”. It is their comments, though, that I find inaccurate, biased and partial. 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Dantas and Fisher took issue with that, alluding to “systematic reviews and metaanalysis in this area that are positive” (rhinitis, post-operative ileus, arthritis). However, their first reference is a “meta-analysis” with three studies by a same author, which was later contradicted by a study with hundreds of patients (one of the studies I mentioned). The second concerned six studies on post-operative ileus, in which, one more time, a negative result appeared in the largest and best designed study (commissioned by the French government to validate two low-quality studies also included in the review). This review also yielded a negative result for studies above 12C, an information included in my paper, since, as I also discussed, it reveals something about why sometimes a positive result is found for homeopathy. 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引用次数: 2

摘要

Dantas和Fisher说我的评论是“选择性的”和“有偏见的”。然而,我发现他们的评论是不准确、有偏见和偏袒的。我的评论查看了顺势疗法的最佳证据,并对其进行了详细的检查,我的结论与许多其他研究人员的结论是一致的,例如,我将对Dantas和Fisher的主要陈述进行详细的分析。1) Dantas和Fisher提到了三个对顺势疗法有积极结果的评论。关于前两篇,他们认为我是“高度选择性的”和“隐瞒”他们的结果,我觉得很好笑,因为我明确表示评论确实发现了顺势疗法的效果。然而,我接着分析了它们的局限性和偏见。这些局限性也被许多其他作者讨论过(例如总结在),而且,正如我提到的,其中一篇评论的作者甚至承认了这些局限性,他们实质上重新考虑了他们的结论。关于第三篇综述,我报告了该综述所能提供的最佳现有证据的结果。有人会不同意这种方法,这让我很惊讶。2) Dantas和Fisher错误地将Linde等人综述中的偏倚“难以估计”的说法归咎于我。这句话,在我论文的引号里,实际上直接来自于审稿。此外,Dantas和Fisher提到的敏感性分析没有考虑质量偏差的综合效应,这是我详细讨论过的一个重要观点(在这方面,读者,以及Dantas和Fisher,应该会在非常说教的Ernst评论中的表1中发现有趣的东西,或者在中的讨论)。3)我引用了林德等人的评论(“……我们发现很少有证据表明任何一种顺势疗法在任何一种临床条件下都是有效的。4)在我的论文中,我引用了一些文献综述和一些研究,我认为它们说明了顺势疗法的负面结果。Dantas和Fisher对此提出异议,暗指“该领域的系统评价和荟萃分析是积极的”(鼻炎,术后肠梗阻,关节炎)。然而,他们的第一个参考文献是同一作者的三项研究的“荟萃分析”,后来被一项涉及数百名患者的研究(我提到的一项研究)所反驳。第二篇涉及六项关于术后肠梗阻的研究,其中规模最大、设计最好的研究(由法国政府委托验证两项低质量研究,也包括在综述中)再次出现阴性结果。这篇综述对12C以上的研究也得出了阴性结果,这是我的论文中包含的信息,因为,正如我也讨论过的,它揭示了为什么有时顺势疗法的结果是阳性的。另一个参考文献是Linde et al论文中所讨论的六项研究的子集,另一项是四项关于关节炎的短期研究,尽管结果是积极的,但仍不能得出确切的结论。事实上,上一篇综述的作者在后来的出版物中总结了他们的结论:“顺势疗法没有明显的发展趋势”。这对我的评论没有任何实质性的补充。5)丹塔斯和费舍尔提到了他们不愿提及的“其他”不准确之处。这不是一种参与科学辩论的恰当方式,我想说的是,这听起来像是一个方便的借口,用来避免我提出的其他非常有害的观点,比如顺势疗法研究中的质量偏差、污染问题、顺势疗法在“证明”中的可怜表现,以及顺势疗法中伪装成“研究”的奇怪物理假设。6) Dantas和Fisher说我“嘲笑”了水中顺势结构效应的可能性。他们认为对这项研究的描述是“嘲弄”,这只能说明事情的可悲状态。正如我所说,对顺势疗法有用的水物理性质的研究历史是漫长而不幸的:水记忆,电冰晶,水晶体,水聚类,顺势疗法制剂的核磁共振分析,以及最近的,顺势疗法的热释光分析。不幸的是,这种努力的结果总是一样的:研究后来被证明是不可复制的,是污染、错误或直接欺诈的产物;也不会增加我们的科学和医学知识。但顺势疗法选择忘记过去的失败
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Homeopathy: do not accept as medicine what has no evidence and contradicts basic science
Dantas and Fisher state that my review is “selective” and “biased”. It is their comments, though, that I find inaccurate, biased and partial. My review looked at the best possible evidence for homeopathy and made a detailed examination of it, and it would suffice to say that my conclusions are on line with those of many other researchers, e.g. I will, however, make a detailed analysis of Dantas and Fisher main statements. 1) Dantas and Fisher mention three reviews with positive results for homeopathy. Concerning the first two of them, I am amused by their suggestion that I was “highly selective” and “concealed” their results, since I made clear the reviews did find an effect for homeopathy. However, I went on to analyze their limitations and bias. These limitations have also been discussed by many other authors (e.g. as summarized in), and, as I mentioned, were even admitted by the authors of one of that reviews, who substantially reconsidered their conclusions. Concerning the third review, I reported the results of the best available evidence the review could provide. It surprises me that someone could disagree with this approach. 2) Dantas and Fisher erroneously attributed to me the statement that the bias in the Linde et al review was “difficult to estimate”. This statement, inside quotation marks in my paper, actually comes directly from the review. Also, the sensitivity analysis Dantas and Fisher mention does not consider the composite effect of quality bias, an important point that I discussed at length (in this respect, the reader, as well as Dantas and Fisher, should find interesting the Table 1 in the very didactic Ernst review, or the discussion in). 3) My citation of the Linde et al review (“...we found little evidence of effectiveness of any single homeopathic approach on any single clinical condition”) is verbatim. 4) In my paper, I cited literature reviews and a few studies that I considered illustrative of the negative results of homeopathy. Dantas and Fisher took issue with that, alluding to “systematic reviews and metaanalysis in this area that are positive” (rhinitis, post-operative ileus, arthritis). However, their first reference is a “meta-analysis” with three studies by a same author, which was later contradicted by a study with hundreds of patients (one of the studies I mentioned). The second concerned six studies on post-operative ileus, in which, one more time, a negative result appeared in the largest and best designed study (commissioned by the French government to validate two low-quality studies also included in the review). This review also yielded a negative result for studies above 12C, an information included in my paper, since, as I also discussed, it reveals something about why sometimes a positive result is found for homeopathy. Another reference is a sub-set of six studies from the discussed Linde et al paper, and the other one, with four short-term studies on arthritis, stated that a firm conclusion could not be made, despite a positive result. In fact, the authors of this last review thus summarized their conclusions, in a later publication: “no clear trend in favor of homeopathy”. This adds nothing of substance to my review. 5) Dantas and Fisher allude to “other” inaccuracies that they would not address. This is not a proper way to engage in scientific debate, and all I am left to say is that it sounds like a convenient excuse for avoiding other very damaging points I made, such as the mentioned quality bias in homeopathic studies, contamination problems, the pathetic performance of homeopathy in “provings” and the bizarre physical hypotheses that disguise as “research” among homeopaths. 6) Dantas and Fisher state that I “mock” the possibility of a homeopathic structural effect in water. That they could consider a description of this research “mocking” only comes to show the sad state of affairs in it. As I said, the research history of water physical properties that could be useful for homeopathy is long and unfortunate: water memory, electric ice crystals, water crystals, water clustering, NMR analysis of homeopathic preparations, and the most recent of these, thermoluminescence analysis for homeopathy. Unfortunately, the result of such endeavor has always been the same: studies are later shown to be nonreplicable, the product of contamination, error or simply forthright fraud; and do not add anything to our scientific and medical knowledge. But homeopaths choose to forget past fail-
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