searching for alternatives: loser pays
Post on 19-Nov-2016
Embed Size (px)
1. Pepe PE, Potkin RT, Reus DH, Hudson LD, Carrico CJ. Clinicalpredictors of the adult respiratory distress syndrome. Am J Surg 1982;144: 124-30.
2. Bone RC, Fisher CJ Jr, Clemmer TP, et al. Sepsis syndrome: a validclinical entity. Crit Care Med 1989; 17: 389-93.
3. Kaplan RL, Sahn SA, Petty TL. Incidence and outcome of therespiratory distress syndrome in gram-negative sepsis. Arch Intern Med1979; 139: 867-69.
4. Fowler AA, Hamman RF, Good JT, et al. Adult respiratory distresssyndrome: risk with common predispositions. Ann Intern Med 1983;98: 593-97.
5. Martin MA, Silverman HJ. Gram-negative sepsis and the adultrespiratory distress syndrome. Clin Infect Dis 1992; 14: 1213-28.
6. Niederman MS, Fein AM. Sepsis syndrome, the adult respiratorydistress syndrome, and nosocomial pneumonia: a common clinicalsequence. Clin Chest Med 1990; 11: 633-56.
7. Montgomery AB, Stager MA, Carrico CJ, Hudson LD. Causes ofmortality in patients with the adult respiratory distress syndrome.Am Rev Respir Dis 1985; 132: 485-89.
8. Seidenfeld JJ, Pohl DF, Bell RC, Harris GD, Johanson WG Jr.Incidence, site and outcome of infections in patients with the adultrespiratory distress syndrome. Am Rev Respir Dis 1986; 134: 12-16.
9. van Deventer SJH, Buller HR, ten Cate JW, Sturk A, Pauw W.Endotoxaemia: an early predictor of septicaemia in febrile patients.Lancet 1988; i: 605-09.
10. Parsons PE, Worthen GS, Moore EE, Tate RM, Henson PM. Theassociation of circulating endotoxin with the development of the adultrespiratory distress syndrome. Am Rev Respir Dis 1989; 140: 294-301.
11. Miyata T, Yokoyama I, Todo S, Tzakis A, Selby R, Starzl TE.Endotoxaemia, pulmonary complications, and thrombocytopenia inliver transplantation. Lancet 1989; ii: 189-91.
12. Danner RL, Elin RJ, Hosseini JM, Wesley RA, Reilly JM, Parillo JE.Endotoxaemia in human septic shock. Chest 1991; 99: 169-75.
13. Brandtzaeg P, Kierulf P, Gaustad P, et al. Plasma endotoxin as a predictorof multiple organ failure and death in systemic meningococcal disease. JInfect Dis 1989; 159: 195-204.
14. Andersen BM, Solberg O. Endotoxin liberation and invasivity ofNeisseria meningitidis. Scand J Infect Dis 1984; 16: 247-54.
15. Bell RC, Coalson JJ, Smith JD, Johanson WG Jr. Multiple organ systemfailure and infection in adult respiratory distress syndrome. Ann InternMed 1983; 99: 293-98.
16. Boucek MM, Boerth RC, Artman M, Graham TP Jr, Boucek RJ.Myocardial dysfunction in children with acute meningococcemia.J Pediatr 1984; 105: 538-42.
17. Vandenroucke-Grauls CMJE, Vandenbroucke JP. Effect of selectivedecontamination of the digestive tract on respiratory tract infectionsand mortality in the intensive care unit. Lancet 1991; 338: 859-62.
18. Fein AM, Lippmann M, Holtzman H, Eliraz A, Goldberg SK. The riskfactors, incidence, and prognosis of ARDS following septicemia. Chest1983; 83: 40-42.
19. Ognibene FP, Martin SE, Parker MM, et al. Adult respiratory distresssyndrome in patients with severe neutropenia. N Engl J Med 1986; 315:547-51.
20. Wortel CH, von der Mohlen AM, van Deventer SJH, et al. Effectivenessof a human monoclonal anti-endotoxin antibody (HA-1A) in gram-negative sepsis: relationship to endotoxin and cytokine levels. J InfectDis 1992; 166: 1367-74.
21. Parsons PE, Moore FA, Moore EE, Ilke DN, Henson PM, Worthen GS.Studies on the role of tumor necrosis factor in adult respiratory distresssyndrome. Am Rev Respir Dis 1992; 146: 694-700.
22. Anon. A nasty shock from antibiotics? Lancet 1985; ii: 594.23. Hurley JC. Antibiotic action and endotoxin [PhD thesis]. Melbourne:
University of Melbourne, 1991.24. Hurley JC. Antibiotic-induced release of endotoxin: a reappraisal. Clin
Infect Dis 1992, 15: 840-54.25. Anon. Endotoxaemia or endotoxinaemia? Lancet 1992; 340: 1323.26. Brandtzaeg P, Bryn K. Kierulf P, et al. Meningococcal endotoxin in lethal
septic shock plasma studied by gas chromatography, mass-spectrometry, ultracentrifugation, and electron microscopy. J ClinInvest 1992; 89: 816-23.
27. Feingold DS. Biology and pathogenicity of microbial spheroplasts andL-forms. N Engl J Med 1969; 281: 1159-70.
28. Madoff S, ed. The bacterial L-forms. New York: Marcel Dekker, 1986.29. Yamamoto A, Homma JY. Isolation of unstable L-forms from clinical
specimens with Pseudomonas infection during antibiotic therapy. Jpn JExp Med 1979; 49: 361-64.
30. Gutman LT, Turck M, Petersdorf RG, Wedgwood RJ. Significance ofbacterial variants in urine of patients with chronic bacteriuria. J ClinInvest 1965; 44: 1945-52.
31. McKay KA, Abelseth MK, Vandreumel AA. Production of anenzootic-like pneumonia in pigs with "protoplasts" of Haemophilusparainfluenzae. Nature 1966; 212: 359-60.
32. Cassell GH, Waites KB, Crouse DT, et al. Association of Ureaplasmaurealyticum infection of the lower respiratory tract with chronic lungdisease and death in very-low-birth-weight infants. Lancet 1988; ii:240-45.
33. Cassell GH, Waites KB, Watson HL, Crouse DT, Harasawa R.Ureaplasma urealyticum intrauterine infection: role of prematurity anddisease in newborns. Clin Microbiol Rev 1993; 6: 69-87.
34. Kreger BE, Craven DE, McCabe WR. Gram-negative bacteraemia: IV.Re-evaluation of clinical features and treatment in 612 patients. Am JMed 1980; 68: 344-55.
35. Moore RD, Lietman PS, Smith CR. Clinical response to aminoglycosidetherapy: importance of the ratio of peak concentration to minimalinhibitory concentration. J Infect Dis 1987; 155: 93-99.
36. Hurley JC. Bacteremia, endotoxemia and mortality in gram negativesepsis. J Infect Dis (in press).
37. Korvick JA, Peacock JE Jr, Muder RR, Wheeler RR, Yu VL. Addition ofrifampicin to combination antibiotic therapy for Pseudomonasaeruginosa bacteraemia: prospective trial using the Zelen protocol.Antimicrob Agents Chemother 1992; 36: 620-25.
38. Tanimoto H. A review of the recent progress in treatment of patients withdiffuse panbrochiolitis associated with Pseudomonas aeruginosainfection in Japan. Antibiot Chemother 1991; 44: 94-98.
Searching for alternatives:loser pays
Some conventional doctors have made it their mission tofight alternative medicine. To them, what is taught in theivory university tower is the only truth, almost by definition."Listen", they argue, "you may feel better after seeing yourfavourite charlatan, but the benefit of his interventions, ifany, is non-specific." At best, they say, alternativepractitioners can be considered masters of placebo therapy.Few patients, however, care about the scientificclassification of their improvement (spontaneous, placebo,or biomedical). They continue to choose the treatment thatthey expect to give them the best overall benefit.
It is always important to optimise placebo effects, in anykind of medicine. But has mainstream medicine somethingextra to offer over alternative medicine? The answer to thatquestion must come mainly from clinical research.
Searching the literatureThe method with the greatest impact for showing clinical
efficacy is the controlled trial. To the surprise of people whoprefer the debate to study of what has been published, thereare many reports of controlled trials of alternative therapies.Sometimes these publications are difficult to trace.Computer databases are biased towards conventionalmedicine because many established journals are reluctant toprint the evidence--especially when it is positive. On theother hand, we also get a biased overview if research initiatedby supporters of alternative medicine is not published whenthe results are disappointing.My experience with alternative researchers is that many
are honest people and welcome any effort to dig up the greyliterature. Sometimes one finds promising data. Theliterature on ginseng, for instance, which cannot be found on
ADDRESSES- Department of Epidemiology, University ofLimburg, PO Box 616, 6200 MD Maastricht, Netherlands(Prof P. Knipschild, MD).
1136 THE LANCET
Medline, shows that it is a helpful tonic for elderly patientswho lack vitality.l Ginkgo biloba has been extensivelystudied in many trials in Germany and France; it seems towork against what the Germans call a TK/eMM.otM(cerebral insufficiency).2 But how many in theAngloamerican rampart of science read foreign languages?
HomoeopathyLet me give one illustration of how exhaustive an
alternative literature search can be. People from mydepartment rolled up their sleeves to look for researchpapers on the effectiveness of homoeopathy. The DutchMinistry of Public Health funded the enterprise.A Medline/Embase search (till 1991) gives 18 published
reports of controlled trials on homoeopathy. Stepwisechecking the references in these publications yields 28 more.If you stop here, you miss more than half of all studies.3We continued browsing through many alternative
journals, including homoeopathic journals. Our rummagein congress reports and doctoral theses in specialisedlibraries in Paris, Hamburg, London, and Glasgow was veryrewarding. Many homoeopathic companies offered help.We wrote to well-known investigators working on thissubject and sometimes paid them a visit. It was importantthat they felt comfortable discussing homoeopathy with us,so our meetings were often held in good restaurants! Weheard details of their studies that were not published andreceived other reports that were still confidential. Ourjourney into homoeopathy produced a pile of more than 100controlled studies. Our subsequent meta-analysis showed,to our astonishment, beneficial effects for homoeopathy inmany (but not all) well-performed trials."
Lately, we have collected many efficacy studies on alltypes of alternative treatments. Many of these studies are notvery convincing becaus