Cochrane review: Homeopathy for treatment of irritable bowel syndrome, 2019, Peckham et al

I came across this other relevant Cochrane review, which again shows just how intellectually broke they are:

Conclusion: Amitriptyline has been a first-line treatment for neuropathic pain for many years. The fact that there is no supportive unbiased evidence for a beneficial effect is disappointing, but has to be balanced against decades of successful treatment in many people with neuropathic pain. There is no good evidence of a lack of effect; rather our concern should be of overestimation of treatment effect. Amitriptyline should continue to be used as part of the treatment of neuropathic pain, but only a minority of people will achieve satisfactory pain relief. Limited information suggests that failure with one antidepressant does not mean failure with all.

So despite there being no evidence we know it works so that's OK, keep using it!!
This comes from the Oxford pain centre.

How do you conclude 'no evidence for lack of effect' in this situation?

And of course you should try a few others if the first one does not work.


(Note that this counts as demedicalising because amitriptyline is given in a homeopathic dose in this situation.)
 
NelliePledge said:
Is Amytriptyline actually proven effective for anything? GPs seem to give it to anyone that mentions sleep or pain - in my opinion it’s just sedation. And when the effect wears off they just want to up the dose. Ugh.
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The Cochrane review is quite revealing. There is no decent evidence but the reviewers say it obviously works anyway so go on using it. This now seems to be the level of Cochrane.
 
Further high quality, adequately powered RCTs are required to assess the efficacy and safety of clinical and individualised homeopathy for IBS
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The last thing that's needed is further "high quality, adequately powered RCTs" of water. It's highly irresponsible of Cochrane to even suggest wasting money and human resources on this. This organisation has gone down the shitter completely.
 
2010 research:

Homeopathy: what does the "best" evidence tell us?


Complementary Medicine, Peninsula Medical School, University of Exeter, Exeter, United Kingdom. Edzard.Ernst@pms.ac.uk
Abstract
OBJECTIVE:
To evaluate the evidence for and against the effectiveness of homeopathy.

DATA SOURCES:
The Cochrane Database of Systematic Reviews (generally considered to be the most reliable source of evidence) was searched in January 2010.

STUDY SELECTION:
Cochrane reviews with the term "homeopathy" in the title, abstract or keywords were considered. Protocols of reviews were excluded. Six articles met the inclusion criteria.

DATA EXTRACTION:
Each of the six reviews was examined for specific subject matter; number of clinical trials reviewed; total number of patients involved; and authors' conclusions. The reviews covered the following conditions: cancer, attention-deficit hyperactivity disorder, asthma, dementia, influenza and induction of labour.

DATA SYNTHESIS:
The findings of the reviews were discussed narratively (the reviews' clinical and statistical heterogeneity precluded meta-analysis).

CONCLUSIONS:
The findings of currently available Cochrane reviews of studies of homeopathy do not show that homeopathic medicines have effects beyond placebo.

https://www.ncbi.nlm.nih.gov/pubmed/20402610


ETA: perhaps Cochrane should do a review of how long should "medicine (?) flog a dead horse."

ETA #2: homeopathics do have an effect beyond placebo - that effect is on bank accounts.
 
Jonathan Edwards said:
I came across this other relevant Cochrane review, which again shows just how intellectually broke they are:

Conclusion: Amitriptyline has been a first-line treatment for neuropathic pain for many years. The fact that there is no supportive unbiased evidence for a beneficial effect is disappointing, but has to be balanced against decades of successful treatment in many people with neuropathic pain. There is no good evidence of a lack of effect; rather our concern should be of overestimation of treatment effect. Amitriptyline should continue to be used as part of the treatment of neuropathic pain, but only a minority of people will achieve satisfactory pain relief. Limited information suggests that failure with one antidepressant does not mean failure with all.

So despite there being no evidence we know it works so that's OK, keep using it!!
This comes from the Oxford pain centre.

How do you conclude 'no evidence for lack of effect' in this situation?

And of course you should try a few others if the first one does not work.


(Note that this counts as demedicalising because amitriptyline is given in a homeopathic dose in this situation.)
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I've seen this line used by many of the most prominent cheerleaders of CBT-GET for ME: there may not be evidence for it but I feel that it works and I have seen it work anecdotally.

Literally the exact argument used to promote snake oil and pseudoscience since forever. It's the only argument one can make when there is no evidence for something.

It's really disappointing to see how common it is, seemingly even more so at the top of the influence pyramid, even the "gold standard" of clinical evidence. All boils down to: you can't prove it doesn't work. Very selectively, of course, they apply the opposite arguments when they don't like what they see. Also a hallmark of snake oil and pseudoscience since always.

Yet somehow we are the antiscience activists. OK, then.
 
One important difference between a snake oil salesmen and CBT/GET proponents is that the latter have political power which allows them to get away with low standards.

CBT/GET people are also good at marketing.
 
Sid said:
The last thing that's needed is further "high quality, adequately powered RCTs" of water. It's highly irresponsible of Cochrane to even suggest wasting money and human resources on this. This organisation has gone down the shitter completely.
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We did a RCT on the need for water. Participants were divided at random into a water or no water group. Those in the water group showed little change. The no water group had a high drop out rate with a high rate of non-compliance for those who remained.
 
Anyone who maintains on a blanket basis that homoeopathy doesn't work should watch a teething baby given Chamomilla 3X teething granules!
 
Annamaria said:
Ingredients:
100g contains 3X homeopathic potency of Matricaria chamomilla, Radix ethanolic decoction 1ml (equivalent to 0.001g Chamomile root in 100g).
Also contains sucrose.
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So in my opinion having something sweet to distract you is likely to be what has the effect. I grew up in the 60s and apparently as a baby had a bit of a taste for gripe water - which in those days had a fair amount of alcohol in it.........
 
NelliePledge said:
My understanding was that it isn’t used much for depression nowadays as it isn’t effective compared to newer medication.
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I'll preface with, don't take my word as gold here, I'm just looking at pubmed.
____

Searching clinical trials on pubmed with terms like 'amitriptyline sertraline' or 'amitryptiline bupropion', the results pretty much all seem to say that amitriptyline is as effective as sertraline (Zoloft) or bupropion (Wellbutrin) (the biggest caveat here is that the outcomes tend to be at ~4-6 weeks). The difference is in the side-effect profile, where amitriptyline's is least-favorable. That's why it isn't first choice. From what I can see it tends to be prescribed in cases where the patient does not respond to SSRIs (sertraline, etc).
 
LOL

20 odd years ago they started me on 75mg a day of ami - it is a little sedating at that dose, and that was the starting dose, when it emerged it wasn't helping my 'depression' she wanted to increase the dose (up to 125mg if memory serves).

I accepted the new script but stopped taking them, I still have bottles of the damn things somewhere.

by 'a little sedating' I mean I sat in a chair and drooled all day.
 
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