Minor effect of loss to follow-up on outcome interpretation in the Swedish spine register.

BACKGROUND AND PURPOSE: Loss to follow-up in observational studies may skew results and hamper study reliability. We evaluated the importance of loss to follow-up in the Swedish spine register. PATIENTS: Patients operated in the lumbar spine and scheduled for a postal questionnaire follow-up during part of 2016 were identified. Out of the 351 patients, 203 had responded. After multiple attempts, 115 of the 148 non-responders were reached; 68 returned the complete questionnaire; and 47 answered a brief questionnaire by phone. Analyses were made with the Chi-square test, analysis of covariance or logistic regression. Some analyses were adjusted. RESULTS: At baseline, the non-responders were younger than the responders (55 vs 61 years, p < 0.001) and had higher Oswestry Disability Index (ODI) (54 vs 48, p = 0.003), lower SF-36 physical component summary score (PCS) (36 vs 40, p = 0.011) and lower EQ-5D (0.17 vs 0.27, p = 0.018). Mean back pain, leg pain, ODI, EQ-5D, SF-36 mental component summary score (MCS) improved significantly in both groups (all p < 0.001). SF-36 PCS did not improve in the non-responder group (p = 0.063). Non-responders perceived less improvement in back pain (global assessment back 60% vs 72%, p = 0.002). At follow-up, there were no differences in patient-reported outcome measures between the groups (all p ≥ 0.06), with the exception of a lower SF-36 MCS among the non-responders (p = 0.015). INTERPRETATION: After surgery for lumbar spine degenerative disorders, non-responders achieve similar outcome as responders in the Swedish spine register, with the exception of a lower mental health and less perceived improvement in back pain. These slides can be retrieved under Electronic Supplementary Material.

Long-term outcome after spinal fusion for isthmic spondylolisthesis in adults.

BACKGROUND CONTEXT: Data on the long-term outcome after fusion for isthmic spondylolisthesis are scarce. PURPOSE: To study patient-reported outcomes and adjacent segment degeneration (ASD) after fusion for isthmic spondylolisthesis and to compare patient-reported outcomes with a control group. STUDY DESIGN/SETTING: A prospective study including a cross-sectional control group. PATIENT SAMPLE: Patients with isthmic spondylolisthesis underwent posterior lumbar interbody fusion (PLIF) (n=86) or posterolateral fusion (PLF) (n=77). Patient-reported outcome data were available for 73 patients in the PLIF group and 71 in the PLF group at a mean of 11 (range 5-16) years after baseline. Seventy-seven patients in the PLIF group and 54 in the PLF group had radiographs at a mean of 14 (range 9-19) years after baseline. One hundred thirty-six randomly selected persons from the population served as controls for the patient-reported outcomes. OUTCOME MEASURES: Patient-reported outcomes include the following: global outcome, Oswestry Disability Index, Disability Rating Index, and Short Form 36. The ASD was determined from radiographs using the University of California Los Angeles (UCLA) grading scale. METHODS: The chi-square test or analysis of covariance (ANCOVA) was used for group comparisons. The ANCOVA was adjusted for follow-up time, smoking, Meyerding slippage grade, teetotaler (yes/no) and, if available, the baseline level of the dependent variable. RESULTS: There were no significant patient-reported outcome differences between the PLIF group and the PLF group. The prevalence of ASD was 42% (32/77) in the PLIF group and 26% (14/54) in the PLF group (p=.98). The patient-reported outcome data indicated lower physical function and more pain in individuals with surgically treated isthmic spondylolisthesis compared to the controls. CONCLUSIONS: PLIF and PLF groups had similar long-term patient-reported and radiological outcomes. Individuals with isthmic spondylolisthesis have lower physical function and more pain several years after surgery when compared to the general population.

"Ultra High Dilution 1994" revisited 2015--the state of follow-up research.

BACKGROUND: The "Ultra High Dilution 1994" project was an endeavour to take stock of the findings and theories on homeopathic extreme dilutions that were under research at the time in areas of biology, biophysics, physics and medicine. The project finally materialized into an anthology assembling contributions of leading scientists in the field. Over the following two decades, it became widely quoted within the homeopathic community and also known in other research communities. The aim of the present project was to re-visit and review the 1994 studies from the perspective of 2015. METHOD: The original authors from 1994 or close laboratory colleagues were asked to contribute papers covering their research efforts and learnings in the period from 1994 up to 2015. These contributions were edited and cross-referenced, and a selection of further contributions was added. RESULTS: About a dozen contributions reported on follow-up experiments and studies, including further developments in theory. Only few of the models that had seemed promising in 1994 had not been followed up later. Most models presented in the original publication had meanwhile been submitted to intra-laboratory, multicentre or independent scrutiny. The results of the follow-up research seemed to have rewarded the efforts. Furthermore, contributions were provided on new models that had been inspired by the original ones or that may be candidates for further in-depth ultra high dilution (UHD) research. CONCLUSION: The project "Ultra High Dilution 1994 revisited 2015" is the latest output of what might be considered the "buena vista social club" of homeopathy research. However, it presents new developments and results of the older, established experimental models as well as a general survey of the state of UHD research.

Perception of Therapeutic Qi, a Nonmechanical, Nonpsychological Factor in Acupuncture That Originates from the Therapist.

So far, most research attempts to explain the mechanism of the action of acupuncture have focused mostly on mechanically-triggered active factors and have produced inconclusive findings. In this study, we investigate whether acupuncture might also involve nonmechanical, nonpsychological active factors originating in the therapist. In 30 individuals, an acupuncture needle was inserted in the acupoint PC6 using a special device without touching the needle. A second device was used to fix the needle rigidly in place, excluding any mechanical transmission of movement from the handle to the needle's tip. Each participant was exposed in random order to a control and a stimulation phase. During the stimulation phase, the free needle's end was held by the therapist to allow the transmission of Qi; during the control phase, it was left untouched. Participants' subjective sensations during the stimulation phase and the control phase were recorded using a questionnaire. Twenty-two of 28 (79%; p = 0.003) test participants believed that they had received stimulation when it had actually been performed, and 26 (93%; p < 0.001) sensed differences between the two experimental phases. Thus, participants were able to sense the transmission of therapeutic Qi in the absence of mechanical or psychological factors.

[Influence of Therapeutic Qi on Heart Rate Variability in Acupuncture: a Randomized Controlled Study]. / Einfluss des therapeutischen Qi auf die Herzratenvariabilität bei Akupunktur: Eine randomisierte kontrollierte Studie.

BACKGROUND: In a recent acupuncture study, volunteers were able to sense stimulation by 'therapeutic Qi' even when mechanical and psychological causes were excluded. Here, we investigated if 'therapeutic Qi' also influences the heart rate variability. METHODS: This was a controlled, randomized, single-blind crossover study with 30 volunteers. Using a special device, an acupuncture needle was inserted in the acupuncture point Pe6. With another device, the protruding end of the needle was fixed so that no transmission of mechanical movement to the tip was possible when the handle was touched. During the experimental intervention, the therapist touched the handle of the needle to stimulate Qi. During the control intervention, the needle was left untouched. During the null intervention, no needle was inserted. Before and after the interventions, parameters of heart rate variability (HRV) were measured. RESULTS: Between the 3 interventions no significant differences in HRV parameters were observed. From pre- to post-measurement the heart rate decreased in the control and experimental interventions (-2 min(-1), d = 0.24 and -2 min(-1), d = 0.24, respectively), RMSSD increased significantly when the needle was touched and Qi was stimulated (+9.7 ms, d = -0.32). CONCLUSION: Within this setting the subjectively perceived stimulation with therapeutic Qi could not be confirmed by using objective HRV measures.

Introduction of two novel devices for investigating the influence of non-mechanical components such as therapeutic qi in acupuncture.

OBJECTIVE: Acupuncture is a complex intervention consisting of specific and non-specific components. Acupuncture studies more frequently focus on collecting data from the patients' perspective and response, but the acupuncturist's role remains relatively unclear. In order to investigate potential non-mechanical active factors originating from the acupuncturist and transmitted to the patient during treatment, two novel devices for basic research in acupuncture were designed. The Acuplicator allows the researcher to insert needles without touching the needles themselves, while the Veliusator locks the needle in its place so that no mechanical movement can be transferred. METHODS: The Acuplicator was used to insert needles at Neiguan (PC6) on the right forearm of 23 volunteers. The insertion depth was measured using a depth gauge. The transfer of mechanical movements from the handle to the tip was detected with a precision length gauge with a motoric-tactile sensor. RESULTS: The mean insertion depth was (12.3 ± 1.5) mm (range 9.5 to 15.0 mm). Even with intense manipulation of the needle handle, no movements within ± 1 µm could be detected at the tip when the needle was locked. CONCLUSION: With these two devices it will be possible to investigate the influence of non-mechanical components such as therapeutic qi in acupuncture.

Reporting experiments in homeopathic basic research (REHBaR)--a detailed guideline for authors.

BACKGROUND: Reporting experiments in basic research in homeopathy is an important issue as comprehensive description of what exactly was done is required. So far, there is no guideline for authors available, unlike criteria catalogues common in clinical research. METHODS: A Delphi Process was conducted, including a total of five rounds, three rounds of adjusting and phrasing plus two consensus conferences. European researchers who published experimental work within the last five years were involved. RESULTS: A checklist of 23 items was obtained and supplemented with detailed examples emphasizing what each item implies. Background, objectives and possible hypotheses should be given in the part 'introduction'. Special emphasis is put on the 'materials and methods' section, where a detailed description of chosen controls, object of investigation, experimental setup, replication, parameters, intervention, allocation, blinding, and statistical methods is required. The section 'results' should present sufficient details on analysed data, descriptive as well as inferential. Authors should discuss their results and give an interpretation in the context of current evidence. CONCLUSION: A guideline for Reporting Experiments in Homeopathic Basic Research (REHBaR) was compiled to be applied by authors when preparing their manuscripts, and to be used by scientific journals in the reviewing process. Furthermore the guideline is a commitment to a certain minimum quality level needed in basic research, e.g. blinding and randomisation. Feedback is encouraged on applicability, strength and limitations of the list to enable future revisions.

[Burnout in general practitioners]. / Burnout bei niedergelassenen Arztinnen und Arzten für Allgemeinmedizin.

BACKGROUND: The term "burnout" refers to emotional and physical exhaustion, indifference, cynicism, a reduced sense of work satisfaction, and social withdrawal, which - apart from internal factors - are contingent upon work overload, a lack of "control" options, i.e., possibilities in self-determination, inadequate financial compensation, breakdown of social networks, absence of fairness, and conflicting basic values. The boundaries between the notions of burnout and depression are porous. METHODS: General practitioners in Tirol were the subject of a survey using the Maslach Burnout Inventory and supplementary items in a questionnaire; the return rate was 41.3 %. RESULTS: Over a third of participants (35.8 %) reported that they were "in danger of burnout"; 27.2 % indicated high burnout values for the categories of emotional exhaustion, 3.2 % for depersonalization, and 10.0 % for cynicism. The mean values were outside of the range which might warrant therapeutic intervention. The study did not reveal any noteworthy correlations based upon either age or gender (p > 0.05). Medical professionals licensed under the national health insurance plan tended to show greater burnout than professionals practicing outside the public plans. GPs who took part in supervisory services reported significantly less burnout. CONCLUSIONS: The data suggests that the topic of burnout in the medical profession in Austria continues to merit study and discussion and that the provision of supervision might be a relevant option.

[The sense of coherence among general practitioners]. / Kohärenzempfinden (Sense of Coherence) bei niedergelassenen Arztinnen und Arzten für Allgemeinmedizin.

The term "sense of coherence" (SOC) refers to a life perspective which spans affective states centering around notions of comprehensibility, manageability, meaningfulness of work or personal contribution, and self-confidence, in a context where demands are perceived as challenges. SOC is positively correlated with psychological well-being, stress management and negatively with anxiety, depression, and neuroticism. General practitioners licensed by the regional health insurance fund in Styria were the subject of a 29-item survey on Sense of Coherence as described by Antonovsky; the return rate was 78.3%. The SOC of GPs replying to the survey was categorized as "marginal" in 29.9% of cases, "significant" in 59.9%, and "rigid" (in the sense of a so-called "inauthentic" self-image) in 10.2% of cases. Overall, the value found was 5.30 +/- 0.56 (Likert scale = absolute 153.8 +/- 16.2; significant), which falls within the range of values for other comparable services or professions, and comes slightly on top over figures for a normative sample. No significant correlations were found for either age or gender (p > 0.05). Reported values for comprehensibility gained in proportion to the age of the general practice of the informant (p < 0.05).

Sense of coherence and physical health. A "Copenhagen interpretation" of Antonovsky's SOC concept.

According to Antonovsky's (Aaron Antonovsky, 1923-1994) sense of coherence (SOC) model, persons with a high SOC have the ability to benefit from their general defense mechanisms in order to overcome stressful situations. In a health-disease continuum, this leads to the development towards health. However, Antonovsky's global hypothesis that the strength of the SOC may influence the physical health status of a person could not be proven. Flensborg-Madsen et al. from Copenhagen were able to provide a new access regarding SOC and health. They investigated the mixture of emotional aspects and mental constructions as a possible cause for fairly low correlation between SOC and physical health. Thus, in an empirical way, they described "emotional coherence" in relation to physical health, while "mental coherence" was linked to psychological health. These authors introduced the idea of applying a shortened version of the original 29-item SOC questionnaire, but have not yet developed or tested the shortened questionnaire. Backed by their important findings, it appears to be promising to consider the use of the SOC questionnaire as standardized by Antonovsky, but cleared of the items regarding "predictability", i.e., Flensborg-Madsen et al. suggested that the items on "predictability" be excluded from the SOC scale when a correlation to physical health is to be investigated. Further investigations in this area of research will be of high impact, not only for health sciences, but also for medical practice.

Treatment of highland frogs from the two-legged stage with homeopathically prepared thyroxin (10-11 - 10-21).

The influence of moderately diluted, agitated, i.e., homeopathically prepared, thyroxin solutions (10-11 - 10-21, final concentration in the basin water 0.6 10-15 - 0.6 10-25 parts by weight after the first application) on metamorphosis in highland Rana temporaria from the two-legged stage was studied. In accordance with the homeopathic idea of effects of specially prepared dilutions being inverse to those of their mother substances, animals were treated either with thyroxin 10-11 - 10-21 or analogously prepared blank solution (water). Development was monitored by documenting the number of animals that had entered the four-legged stage. It has been found that animals treated with the thyroxin solutions metamorphosed more slowly than the control animals, i.e., the effect of the homeopathically prepared thyroxin was opposed to the usual effect of molecular thyroxin. The number of test animals that reached the four-legged stage at defined points in time was smaller (2-13.5%) in the group treated with homeopathically prepared thyroxin at the points in time, compared to control. The results in this study sustain the previous multiresearcher findings that show that diluted homeopathically prepared thyroxin is able to slow down metamorphosis of R. temporaria.

The effect of homeopathically prepared thyroxine on highland frogs: influence of electromagnetic fields.

BACKGROUND: Previous experiments show that amphibian larvae are responsive to homeopathically prepared thyroxine. METHODS: We studied the effect of a highly diluted and agitated thyroxine solution exposed to various electromagnetic fields on metamorphosis in highland Rana temporaria. The devices tested were: microwave oven, mobile phone, airport X-ray, and a red light barcode scanner. Animals were treated either with homeopathically prepared thyroxine (10(-30) parts by weight, 10(-35) in the water in which the animals were kept), or analogously prepared blank solution, or analogously prepared thyroxine exposed to the electromagnetic field of one of the devices tested. Solutions were administered at 48h intervals according to a standardized protocol. RESULTS: Animals treated with the standard test solution thyroxine 10(-30) metamorphosed more slowly than the control animals, ie the effect of the homeopathically prepared thyroxine was opposed to the usual physiological effect of molecular thyroxine. The cumulative number of test animals that had reached the four-legged stage at defined points in time was smaller in the group treated with homeopathically prepared thyroxine at most of the points in time. This was found independently by all three research teams involved. In contrast, this effect did not occur when the thyroxine solution had been exposed to the field of the early model microwave oven, or mobile phone. There was no difference between aqueous or alcoholic solutions were used, and there was, if any, only a small protective effect from aluminum foil. Airport X-ray and red light barcode scanning did not diminish the effect of the homeopathic solution.

Treatment of lowland frogs from the spawn stage with homeopathically prepared thyroxin (10(-30)).

The influence of a highly diluted agitated, i.e. homeopathically prepared thyroxin solution (10(-30), final concentration in the basin water 10(-35) parts by weight after the first application) on metamorphosis in lowland Rana temporaria from the spawn stage on was studied. The treatment with homeopathically prepared thyroxin solution (10(-30)) starts at the frogspawn stage. It represents a tool to learn more about the previously standardized amphibian model, where the thyroxin solution was applied from the two-legged stage on only. Lowland frogs were pretreated by immersing spawn in an aqueous molecular thyroxin dilution (10(-8) parts by weight). In later stages of development (2 to 4 legged), this has been found to speed up metamorphosis by around 15%. In accordance with the homeopathic idea of detoxication or cure, hyperstimulated animals (spawn or, in subsequence, larvae) were treated either with thyroxin that had been highly diluted and agitated in successive steps, i.e. homeopathically prepared (10(-30)), or analogously prepared blank solution (water). Development was monitored by documenting the number of animals that had entered the four-legged stage. It has been found that animals treated with the test solution metamorphosed more slowly than the control animals, i.e. the effect of the homeopathically prepared thyroxin was opposed to the usual effect of molecular thyroxin. The number of test animals that reached the 4-legged stage at defined points in time was slightly smaller in the group treated with homeopathically prepared thyroxin at some, but not at all points in time, compared to control. The results in this study sustain the previous multi researcher findings that highly diluted homeopathically prepared thyroxin is able to slow down metamorphosis of Rana temporaria.

Individual prognosis regarding effectiveness of a therapeutic intervention using pre-therapeutic "kinesiology muscle test".

Since a therapy's full positive effect and possible adverse effects are individual and not predictable for every single patient, scientists have been searching for methods to predict optimal effects of a therapy. This pilot study investigated the applicability of the "kinesiology muscle test" as a prognostic tool regarding effectiveness in a defined therapeutic procedure. Each of 11 test persons with elevated total cholesterol values received a naturopathic drug supposed to lower cholesterol level on a daily basis for eight consecutive weeks. Prior to treatment the "kinesiology muscle test" was performed, where the patients' ability to maintain a flexed position in a selected joint was evaluated. The resistance created by the patient against the tester's pressure was monitored. Being in touch with healthful or unhealthful chemical substances may, according to the kinesiology literature, increase or decrease this resistance. For testing purposes, the drug was placed onto the patients' skin. The ability of the brachioradial muscle to resist the tester's pressure was determined on a subjective scale (0-100%). The Pearson product-moment correlation coefficient between four variables (total cholesterol value before therapy, total cholesterol value after therapy, difference of total cholesterol values before and after therapy, prior to treatment kinesiology testing) was chosen. A significant correlation between the difference of total cholesterol values before-after and the prior to treatment test was found, as well as a significant correlation between the total cholesterol values after therapy and the prior to treatment kinesiology test.

Influence of artificial sweetener on human blood glucose concentration.

Artificial sweeteners, such as saccharin or cyclamic acid are synthetically manufactured sweetenings. Known for their low energetic value they serve especially diabetic and adipose patients as sugar substitutes. It has been hypothesized that the substitution of sugar with artificial sweeteners may induce a decrease of the blood glucose. The aim of this study was to determine the reliability of this hypothesis by comparing the influence of regular table sugar and artificial sweeteners on the blood glucose concentration. In this pilot-study 16 patients were included suffering from adiposity, pre-diabetes and hypertension. In the sense of a cross-over design, three test trials were performed at intervals of several weeks. Each trial was followed by a test free interval. Within one test trial each patient consumed 150 ml test solution (water) that contained either 6 g of table sugar ("Kandisin") with sweetener free serving as control group. Tests were performed within 1 hr after lunch to ensure conditions comparable to patients having a desert. Every participant had to determine their blood glucose concentration immediately before and 5, 15, 30 and 60 minutes after the intake of the test solution. For statistics an analysis of variance was performed. The data showed no significant changes in the blood glucose concentration. Neither the application of sugar (F(4;60) = 1.645; p = .175) nor the consumption of an artificial sweetener (F(2.068;31.023) = 1.551; p > .05) caused significant fluctuations in the blood sugar levels. Over a time frame of 60 minutes in the control group a significant decrease of the blood sugar concentration was found (F(2.457;36.849) = 4.005; p = .020) as a physiological reaction during lunch digestion.

ABO blood group. Related investigations and their association with defined pathologies.

The ABO blood group system was discovered by Karl Landsteiner in 1901. Since then, scientists have speculated on an association between different pathologies and the ABO blood group system. The aim of this pilot study was to determine the significance between different blood types of the ABO blood group system and certain pathologies. We included 237 patients with known diagnosis, blood group, sex, and age in the study. As a statistical method, the Chi-square test was chosen. In some cases, a significant association between the blood groups and defined diseases could be determined. Carriers of blood group O suffered from ulcus ventriculi and gastritis (X(2)1 = 78.629, p < 0.001), colitis ulcerosa and duodenitis (X(2)1 = 5.846, p < 0.016), whereas male patients carrying blood group A tended to contract different types of tumours. In patients with intestinal tumours, females with blood group A were more likely to develop the pathology, whereas in males, the blood group O dominated. The development of cholelithiasis was found, above all, in patients with blood group O, which differed from other research where a correlation between this pathology and blood group A was found.

Pretreatment with thyroxin 10(-8) and the effect of homeopathically prepared thyroxin 10(-30) on highland frogs--a multi-researcher study.

BACKGROUND: Studies performed in 5 laboratories have shown that homeopathically prepared highly diluted thyroxin (10(-30)=30x) slowed down metamorphosis of highland amphibians. Metamorphosis of lowland amphibians, however, could be slowed down by a low dilution of thyroxin (10(-8)=8x) if animals had been artificially pretreated with thyroxin. OBJECTIVE: To combine the advantages of using animals from highland biotopes and hyperstimulation prior to treatment. ANIMALS AND METHODS: Rana temporaria from an alpine biotope were pretreated in an aqueous molecular thyroxin dilution (10(-8) parts by weight, hyperstimulation). This is supposed to accelerate metamorphosis. In accordance with the homeopathic idea of detoxification or cure, one group of these hyperstimulated animals was then treated with thyroxin 30x, and another group with water 30x. Experiments were performed by 4 independent researchers. RESULTS: As a trend, the thyroxin-30x animals metamorphosed more slowly than the water-30x animals. The number of thyroxin-30x animals that reached the 4-legged stage at defined points in time was slightly smaller at some but not all points in time, compared to control. This is in line with previous findings and can be discussed as an interesting result. Contrary to our working hypothesis, however, differences were not bigger than in the previous experiments in which animals had not been pretreated with thyroxin 10(-8). CONCLUSION: This study supports previous findings but does not prove the assumption that pretreatment of highland animals with molecular thyroxine improves the original protocol.

Sense of coherence (SOC) among psychotherapists in Austria, differentiated according to number of individually completed training therapy sessions.

The sense of coherence (according Aaron Antonovsky, 1923-1994, when a person's sense that his/her own life and the world are sufficiently comprehensible, manageable, and meaningful) of Austrian psychotherapists was assessed and compared with a standard sample, as well as with the sense of coherence (SOC) of members of other professions. In addition, the question as to whether psychotherapists who had completed more extensive individual training therapy/self-awareness sessions had a higher SOC than do those with fewer, was addressed. Forty psychotherapists who worked in private practices and various psychosocial health care institutions in Styria, Austria took part in the study. The investigation was conducted in the form of a questionnaire assessment. The evaluation showed that the overall SOC value of the professional group in question was significantly higher than that of the standard sample (162.3 vs. 145.7), as well as other samples (physicians: SOC = 153.8; teachers: SOC = 156.1; physiotherapists SOC = 158.1). Concerning whether psychotherapists who had completed more individual training therapy/self-awareness sessions had higher SOC values than did those with fewer, we found no difference in regard to the overall SOC score or SOC scores for individual components. The SOC of psychotherapists did not seem to depend on the number of additional training therapy/self-awareness sessions.

Pretreatment with thyroxine (10-(8) parts by weight) enhances a 'curative' effect of homeopathically prepared thyroxine (10-(13)) on lowland frogs.

We studied the influence of a moderate homeopathically prepared thyroxine dilution (final concentration in the basin water 10-(13) parts by weight) on the metamorphosis of lowland Rana temporaria which had been hyperstimulated with thyroxine. Two groups of animals were pretreated by immersing them in a molecular thyroxine dilution (10-(8) parts by weight). This pretreatment speeds up development, as is well known. In accordance with the homeopathic/isopathic idea of detoxication or cure, the same hormone was then diluted and agitated in successive steps for further treatment. This homeopathically prepared dilution was administered at 24-hour intervals to one of the groups. An analogously prepared blank solution was used for the control group. Our hypothesis, which was derived from earlier studies, was that animals treated with the test solution would metamorphose more slowly than the control animals, i.e. that the homeopathically prepared thyroxine would have a 'curative' effect. In this new series of experiments this hypothesis was examined by 3 independent researchers. In the experiments carried out by 2 of the 3 researchers the number of animals that reached the four-legged stage at defined points in time was smaller in the group treated with homeopathically prepared thyroxine. In the third laboratory no difference was found between the groups. However, the overall inhibiting effect was statistically significant and more pronounced than in earlier, less promising studies and in parallel experiments in which nonprestimulated animals had been used. Other studies carried out by the 3 researchers involved animals from highland biotopes, where the natural environment probably induces a greater sensitivity towards thyroxine or higher thyroxine levels. These animals reacted to the homeopathically prepared thyroxine with a slowing down of metamorphosis, even when they had not been prestimulated with a molecular dose of the hormone. This effect was observed in all 3 laboratories and is consistent with the results of previous studies.