How to avoid the medicare $7 co-payment.

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The Federal Budget had a few surprises in it however overall for many families your cost of living will increase. Whether its the 2% debt levy, loss of the Family Tax Benefit or the $7 co-payment that will be introduced if they get it through the senate

One of the best things you can do to reduce your cost of living is to look after your health. Fewer visits to the GP means fewer co-payments and also fewer hours you spend waiting and waiting!
I always remember as a new mum panicking when my children were sick. One of the things I try to get mum’s confident about when I run my homeopathic first aid course is when they can treat something themselves and when they should get straight to the GP. For example in a small child if the temperature is over 39.5c and they are floppy or disorientated seek medical attention as soon as possible.

There are some simple ways to improve your health and making these changes could help reduce the number of times you have to shell out for the co-payment. These include;

1) Eat well – lots of fresh fruit and vegetables (still not GST on those) and small amounts of lean protein.

2) Add good sources of probiotics – it could be a supplement or fermented foods such as yoghurt, kim chi, sauerkraut or keffir (much cheaper options). Good gut bacteria are your first line of defence for your immune system.

3) Exercise – you don’t need to join a gym just put the baby in the stroller or take the kids to the park and walk for half an hour a day – your stress levels will reduce and you will be less prone to infections.

4) Learn more about first aid through St John’s or do my Homeopathic First Aid Course. Its much easier to make a decision about health if you know when you should panic!

Christine Pope is a homeopath and nutritionist based at Elemental Health, St Ives. She is also head of nutrition at Nature Care College where she supervises nutrition clinic and lectures in Homeopathy. She can be contacted for appointments on 8084 0081.

Research – can we research natural medicine?

A recent blog talked about how easy it was to poke holes in research so with this one I will look at some of the challenges when you are researching natural medicine interventions, such as homeopathy.

First up most clinical trials are set up on the basis of giving a patient one treatment and seeing how it compares to another or to placebo. Most of the time in natural medicine we don’t just give one thing so that does make it difficult to see how a more complex treatment works.

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The first part of a consultation is really listening to your client for 45 minutes to an hour, depending on how long that initial consultation takes. Think about the value of really being heard for up to an hour. This process gives the practitioner time to think about how the whole person is affected by what is happening to them and what may need treatment. Sometimes I find in that time the solutions become clear to the patient and just that process alone can be invaluable in helping them heal.

How do we measure this?  There are tools in which natural medicines such as homeopathy perform quite well .  Valid forms of evidence  including case studies, patient reports of satisfaction , quality of life and observational studies. Here, homeopathy does much better than in Randomised Controlled Trials.

One of the largest observational studies was undertaken by the National Health Service in the UK. It involved a total of 6544 consecutive follow-up patients who were given outcome scores. The patients were all using homeopathic treatment for chronic diseases. Of the patients 70.7% reported positive health changes, with 50.7% recording their improvement as better or much better (1). A similar study undertaken at an Italian hospital in Lucca also showed 74% of patients reporting improvement with the most common conditions being respiratory, dermatological and gastrointestinal.

Isn’t this a better way to assess the value of a treatment like homeopathy?  A research tool which looks at the outcomes for the patient in terms of quality of life and improvement in their health.

 

 

(1) Spence DS1, Thompson EA, Barron SJ., J Altern Complement Med. 2005 Oct;11(5):793-8., Homeopathic treatment for chronic disease : a 6 year University- Hospital  outpatient observational study.

Research – is it all lies, lies and damned statistics?

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A recent press release by the National Health and Medical Research Council (NHMRC) stated that where there was evidence to support the use of homeopathy the trials were too small and not well designed. Its kind of damning with faint praise isn’t it?? By the way most of the headlines were a lot less favourable but I read the detail of the report.

So I decided to write about research and try and explain what is contained in the report and perhaps shed a little light on the whole process. I did try and avoid a lot of maths in this discussion but this is going to be a little longer than my usual blog as it covers a fair amount of information.

Research – hierachy and different types

First up there is a hierachy in terms of research evidence in western medicine. At the top of the research hierachy is the randomised controlled trial (RCT) , which is regarded as the gold standard of evidence. Unfortunately it takes a lot of gold to meet the gold standard and it will always be more difficult with natural medicine which can’t really patent its findings to generate the types of revenues that fund this standard of research.

How much of western medicine is based on the gold standard of RCT’s? Surprisingly a lot less than you would think. Back in the 1980’s when the Cochrane Collection was established only 10- 15% of drugs in use had been subject to this research. The rest of the time they relied on long term clinical use (kind of like a lot of natural medicine). That number has at least doubled in part due to the efforts of the Cochrane Collection which is an independent research body promoting the use of evidence based research in clinical decision making.

Before you get to the RCT however there are other forms of research which contribute to the picture , this can include case study reports, in vitro research (cells in a test tube), animal studies and cohort studies, case control studies and clinical use. A case study report is usually a report which can highlight problems with an existing treatment or a way of dealing with a case which yields some new information. Studies on cells in test tubes or animals may be done at the start of research. They are  not considered as reliable as human trials as humans may react differently to animals.

Case control studies try to identify what is different between a group who have developed a condition and those who didn’t. They tend to be more cost effective but not always as reliable as a Cohort study where participants are tracked over a long period of time. Try remembering what you were eating like ten years ago? See? Its really not that easy. A Cohort study that tracks it over time can document what you were eating at different times in your life and see if the group who develop a condition were eating differently or eating more of a particular food group.

How do we design an RCT?

Whilst the RCT is the gold standard its fairly hard to find any RCT that is perfect. Typically an RCT is set up to compare one treatment against another or against placebo. You then recruit a group of people to your trial who need treatment for that condition – therefore you need to make sure they have the type of condition that will respond to your drug. To avoid complications you try to exclude people in the research who have other conditions as well. In the US students are often happy to participate in those trial’s as its a good way to earn some extra money.

So is that group of people you have just recruited to your study the same as the group of people who will ultimately take your drug? Quite often people as they get a little older are on multiple medications and they aren’t as robust as the group of students who did the trial.

So in your analysis you have just looked at the recruitment of participants and already you may not be that happy with the design.

See how easy it is to start to poke holes in the design of any trial and I haven’t even looked at numbers of participants yet?

Size of trial

To determine how many people you need in a trial you need to look at what the size of the treatment effect is and then a calculation is done (called a power calculation) to determine how many participants you need in your trial at the end to be able to see that the treatment effect is actually statistically significant.

This means a bigger group doesn’t add up to better research. It tends to mean that the smaller benefit someone gets from treatment the larger the group you need to show that it was ┬ástatistically significant and didn’t just occur by random chance. When newer drugs are being trialled against older drugs you often see only small improvements in the treatment so large scale trials will be needed.

Most natural medicine trials are quite small as funding is usually restricted however there are processes in place to ensure that the size of the group is adequate to measure the treatment effect. The NHMRC was generally negative about the fact that so few of the homeopathic trials had in excess of 500 participants but neglected to explain why that may not be necessary. They completely omitted the explanation of power calculations or whether in fact these indicated that smaller studies were still reliable evidence. Sometimes its not all about size!

Natural Medicine and RCT’s

In the next blog I will look at some of the reasons why natural medicine doesn’t fit well into the world of RCT’s. I was going to cover it here but its already a bit long!! Would love to hear your thoughts so please feel free to comment.