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Research: LINDE and colleagues,
Listed in Issue 74
Abstract
LINDE and colleagues, Institute for Social Medicine, Epidemiology, Charite, Humboldt-University, Berlin, Germany, Klaus.Linde@1rz.tu-muenchen.de, examined the quality of methodologies used in randomized controlled trials (RCTs) in three areas of complementary medicine (homeopathy, herbal medicine and acupuncture).
Background
Methodology
The authors analysed 207 RCTs identified for inclusion in five previously published systematic reviews on homeopathy, herbal medicine (Hypericum for depression ; Echinacea for common cold ) and acupuncture (for asthma and chronic headache ). They used a validated assessment scale (the Jadad scale) and analysed single quality items.
Results
The quality of the methods used in the different trials varied widely. Most trials had serious short-comings in reporting and/or methods. Most trials failed to adequately describe concealment of treatment allocation [blinding] or report drop-outs or withdrawals. Homeopathy and herbal medicine trials reported adequate allocation concealment more often (32% and 26% ) than did acupuncture trials (6% ). Herbal medicine trials had better summary scores than homeopathy and acupuncture trials. Larger trials published more recently in journals listed on MEDLINE and in English had fewer methodological short-comings than trials not meeting these criteria.
Conclusion
Clinical trials of complementary therapies frequently have important methodological weaknesses, the types of which vary considerably across interventions.
References
Linde K et al. The methodological quality of randomized controlled trials of homeopathy, herbal medicine and acupuncture. International Journal of Epidemiology 30 (3): 526-31. Jun 2001.
Comment
What Linde et al report above is beyond reproach, with regard to methodology of randomized controlled trials (RCTs). The problem is, however, that in the enthusiasm for this brand of 'evidence-based medicine' (RCTs), other important and not invalid (in the eyes of other scientists and clinicians) methods of clinical research don't get mentioned. The message that gets communicated to the outside world is not that the methodology is imperfect, rather that there is no research and no evidence. We are being taken over by the RCT brigade.
