Is the increasing use of evidence-based pharmacotherapy causing the renaissance of complementary medicine?
Is the increasing use of evidence-based pharmacotherapy causing the renaissance of complementary medicine?
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DOI：
10.1046/j.0306-5251.2003.01879.x
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发表时间：
2003-09-01
影响因子：
3.4
通讯作者：
Vozeh, S
中科院分区：
文献类型：
--
作者：
Vozeh, S
这篇简短的评论考虑了迄今为止很少讨论的一个可能导致补充药物使用增加的因素：在循证医学背景下使用安慰剂的困难，这代表了大多数西方文化国家当前药物治疗的标准。它讨论了在某些疾病中安慰剂与活性化合物相比具有相似或更好的获益-风险特征的可能性，并展示了三个可以从临床试验中得出结论的例子（失眠、过敏性鼻炎、肠易激病）。在这种情况下，有人建议补充医学取代安慰剂疗法。由此，该评论并没有否认（也没有讨论）补充药物除安慰剂效应之外的效应的可能性。然而，它认识到补充医学对安慰剂效应的治疗应用持开放态度，即使用声称在类似情况下有效并且可能对实际患者有效的药物，而不需要确凿的数据显示优于安慰剂的效果。医生可能更愿意使用补充药物来治疗安慰剂效应较高的适应症，传统疗法存在副作用风险，并且省略药理活性化合物治疗不会导致不可逆的损害。监管机构可能不应该要求在对照临床试验中证明与安慰剂相比的有效性。然而，无论何时在这个意义上使用，补充药品必须明确证明其在成分和药品质量方面的安全性。不幸的是，情况并非总是如此。
This brief commentary considers a possible hitherto infrequently discussed factor that might contribute to the increase in the use of complementary medicines: the difficulties of using placebo within the context of evidence-based medicine, which represents the current standard for pharmacotherapy in most western culture countries. It discusses the possibility of placebo having a similar or better benefit-risk profile compared with an active compound in some diseases, and shows three examples in which this can be concluded from a clinical trial (insomnia, allergic rhinitis, irritable bowel disease). It is proposed that complementary medicine has under these circumstances taken the place of placebo therapy. By this, the commentary does not deny (and does not discuss) the possibility of an effect of complementary medicines other than the placebo effect. However, it recognizes that complementary medicine is open to the therapeutic application of the placebo effect by using a medicine with the claim that it has worked in similar situations and may work in the actual patient, without requiring hard data showing superiority to placebo. Physicians might be more open to the use of complementary medicines for indications in which the placebo effect is high, the conventional therapy carries a risk of side-effects and the omission of treatment with a pharmacologically active compound does not result in irreversible damage. The regulators on their part should probably not require proof of effectiveness compared with placebo in controlled clinical trials. However, whenever used in this sense, the complementary medicine product must unequivocally demonstrate its safety with respect to both the ingredients and the pharmaceutical quality. This is unfortunately not always the case.