Parenteral oestrogen in the treatment of prostate cancer: a systematic review.

The objectives of this study were to assess the effectiveness and safety of parenteral oestrogen in the treatment of prostate cancer, and to examine any dose relationship. A systematic review was undertaken. Electronic databases, published paper and internet resources were searched to locate published and unpublished studies with no restriction by language or publication date. Studies included were randomised controlled trials of parenteral oestrogen in patients with prostate cancer; other study designs were also included to examine dose-response. Study selection, appraisal, data extraction and quality assessment were performed by one reviewer and independently checked by another. Twenty trials were included in the review. The trials differed with regard to the included patients, formulation and dose of parenteral oestrogen, comparator used, outcome measures reported and the duration of follow-up. The results provide no evidence to suggest that parenteral oestrogen, in doses sufficient to produce castrate levels of testosterone, is less effective than luteinising hormone-releasing hormone (LHRH) or orchidectomy in controlling prostate cancer, or that it is consistently associated with an increase in cardiovascular mortality. Further well-conducted trials of parenteral oestrogen are required. A pilot randomised controlled trial comparing transdermal oestrogen to LHRH analogues in men with locally advanced or metastatic prostate cancer is underway in the United Kingdom.

Homeopathy for attention deficit/hyperactivity disorder or hyperkinetic disorder.

BACKGROUND: Homeopathy is one form of complementary/alternative medicine which is promoted as being a safe and effective form of treatment for children and adults. Within the UK homeopathy use is estimated at 1.9% of the adult population (Thomas 2004), and around 11% for children under 16 years (Simpson 2001). There has been increased interest in homeopathy's potential as a non-pharmacological intervention for attention deficit/hyperactivity disorder as an alternative to the use of stimulant medications such as Ritalin. Homeopathy is a system of medicine based on the principle of treating "like with like" using various dilutions of natural or man-made substances. Homeopathy focuses on the unique characteristics of each patient's experience and symptomatology and uses this information to determine the appropriate prescription for each patient. OBJECTIVES: To assess the safety and effectiveness of homeopathy as a treatment for attention deficit/hyperactivity disorder. SEARCH STRATEGY: We searched a wide set of databases from their inception to March 2006 including: CENTRAL, MEDLINE, AMED, BIOSIS, CISCOM, CINAHL, Dissertation Abstracts, ECH (European Committee for Homeopathy thesis database), EMBASE, ERIC, HomInform (Glasgow Homeopathic Hospital Library), LILACS, PsycINFO, Science Citation Index, SIGLE, GIRI - International congress on ultra-low doses, Liga Medicorum Homeopathica Internationalis. We contacted experts in the field about ongoing or current research. SELECTION CRITERIA: All studies where individualised, clinical or formula homeopathy had been used to treat participants with ADHD or HKD who were randomly or quasi-randomly allocated to either true treatment or a control were selected. Control groups could include wait-list, no treatment, medication, placebo homeopathy, educational or behavioural interventions. DATA COLLECTION AND ANALYSIS: Data from four eligible studies (total n = 168) were extracted and entered into RevMan. Results were synthesised and estimates of the effect sizes were calculated and presented as appropriate (using standardised mean differences) in both graphical and narrative form (narrative only was used where no effect size calculation was possible). MAIN RESULTS: The forms of homeopathy evaluated to date do not suggest significant treatment effects for the global symptoms, core symptoms of inattention, hyperactivity or impulsivity, or related outcomes such as anxiety in Attention Deficit/Hyperactivity Disorder. AUTHORS' CONCLUSIONS: There is currently little evidence for the efficacy of homeopathy for the treatment of ADHD. Development of optimal treatment protocols is recommended prior to further randomised controlled trials being undertaken.

Reporting data on homeopathic treatments (RedHot): a supplement to CONSORT.

When homeopathy is tested in clinical trials, understanding and appraisal is likely to be improved if published reports contain details of prescribing strategies and treatments. An international Delphi panel was convened to develop consensus guidelines for reporting homeopathic methods and treatments. The panel agreed 28 treatment- and provider-specific items that supplement the Consolidated Standards of Reporting Trials (CONSORT) Statement items 2, 3, 4 and 19. The authors recommend these for adoption by authors and journals when reporting trials of homeopathy.

Management of colorectal cancers.

The management of colorectal cancers, published in a recent issue of Effective Health Care, is reviewed.

More trials, fewer placebos, please.

The argument that randomized placebo-controlled trials of homeopathy might usefully be replaced by observational studies, audit and quality-of life assessment is considered. Randomized equivalence and patient-preference trials are proposed as more informative alternatives. They have the merit of providing hard information for health services on the comparative value of treatments, and can facilitate internal comparisons of competing homeopathic methods. The pragmatic approach also allows clinical change during the homeopathic treatment of chronic disease to be assessed without the time constraints usually imposed by placebo controls.

A homeopathic origin for placebo controls: 'an invaluable gift of God'.

The acknowledged early adoption of placebo controls in drug trials by homeopaths is currently thought to have been derived from prior external attempts to discredit the system. This claim is reexamined in the light of a comprehensive literature search for 19th-century homeopathic therapeutic trials and provings using placebo. Single-blind placebo controls, still used today, are shown to have originated independently within homeopathy's own disciplinary matrix before the first external evaluations. They are the most likely source for later placebo-controlled crossover and parallel group experiments by homeopaths.

Hepatic microsomal metabolism of drugs during pregnancy in the rat.

A progressive depression in the in vitro hepatic microsomal enzyme metabolism of drug substrates, during pregnancy in the Wistar rat, was measured against various parameters. This depression was greatest with aniline para-hydroxylation and least with p-nitrobenzoic acid reduction. The depressed metabolism, which correlated with prolonged in vivo hexobarbital sleeping times, was paralleled by falls in hepatic microsomal cytochrome P-450 levels. There was a rapid reversal of this depression just before delivery, but these changes did not appear to be controlled by progesterone levels. The suggestion is advanced that the lower levels of hepatic microsomal enzyme activity might reflect a biological control mechanism to ensure the elevated levels of progesterone required to maintain the pregnant state. The relationship between changes in liver weight and enzyme activity was also examined as a possible explanation of the observed depression in drug metabolism during pregnancy.