George Lewith - Academia.edu (original) (raw)

Papers by George Lewith

É Research funding for CAM is inadequate, resulting in too few good quality studies to support it... more É Research funding for CAM is inadequate, resulting in too few good quality studies to support its use. É Widespread use of CAM, as well as its media promotion, make this a vital public health issue, and the Australian,government,has,a social and,ethical,obligation,to respond,by developing,a research,infrastructure,(as has,been,done,by the United Kingdom and,United,States governments). É ,We propose,a funding model,that neither draws,directly from the

We have systematically researched and reviewed the literature looking at the effect of acupunctur... more We have systematically researched and reviewed the literature looking at the effect of acupuncture on brain activation as measured by functional magnetic resonance imaging and positron emission tomography. These studies show that specific and largely predictable areas of brain activation and deactivation occur when considering the traditional Chinese functions attributable to certain specific acupuncture points. For example, points associated with hearing and vision stimulates the visual and auditory cerebral areas respectively. Pain, however, is a complex matrix that is intimately intertwined with expectation. Acupuncture clearly affects this matrix in both specific and non-specific manner that is consistent with its specific clinical effects, as well as the effects of expectation on pain relief. This article summarizes the current imaging literature.

Evidence-based complementary and alternative medicine : eCAM, 2014

Digital interventions are becoming an increasingly popular method of delivering healthcare as the... more Digital interventions are becoming an increasingly popular method of delivering healthcare as they enable and promote patient self-management. This paper provides a methodological guide to the processes involved in developing effective digital interventions, detailing how to plan and develop such interventions to avoid common pitfalls. It demonstrates the need for mixed qualitative and quantitative methods in order to develop digital interventions which are effective, feasible, and acceptable to users and stakeholders.

PloS one, 2014

Chinese proprietary herbal medicines (CPHMs) have long history in China for the treatment of comm... more Chinese proprietary herbal medicines (CPHMs) have long history in China for the treatment of common cold, and lots of them have been listed in the 'China national essential drug list' by the Chinese Ministry of Health. The aim of this review is to provide a well-round clinical evidence assessment on the potential benefits and harms of CPHMs for common cold based on a systematic literature search to justify their clinical use and recommendation. We searched CENTRAL, MEDLINE, EMBASE, SinoMed, CNKI, VIP, China Important Conference Papers Database, China Dissertation Database, and online clinical trial registry websites from their inception to 31 March 2013 for clinical studies of CPHMs listed in the…

Homeopathy, 2000

Introduction: Hering's 'Law of Cure' is considered important in homeopathy and thought to predict... more Introduction: Hering's 'Law of Cure' is considered important in homeopathy and thought to predict a positive outcome to treatment. No formal outcome measures are currently available to monitor response to homeopathic treatment on the basis of these assumptions. We describe a simple assessment tool, the Hering's Law Assessment Tool (HELAT) to identify and differentiate patient responses to homeopathic treatment as corresponding to Hering's Law from other symptomatic responses. We describe the development of the tool and assess its face, content and predictive validity. Method: The HELAT was initially developed through literature review, discussion between homeopaths and clinical experience. In phase one, the tool was reviewed by three experienced homeopaths to assess face and content validity. In phase two, we tested its predictive validity by hypothesizing that the HELAT total score may predict changes in a clinical response (using standard validated rheumatological outcome, the American College of Rheumatology (ACR)20%) in 32 patients with rheumatoid arthritis receiving homeopathic intervention over 24 weeks as part of a clinical trial. Results: The HELAT was piloted and changed to improve face and content validity and the final version was then employed for phase two as a predictor of outcome. HELAT total score predicted patient's clinical response (ACR20) [B = 1.142, SE = 0.462, P = 0.013] which was independent of practitioner assessing the patients treatment response [B = 1.04, SE = 1.01, P = 0.302]. Conclusion: The initial data suggests that the HELAT may hold promise for a potential clinical and research outcome measure in homeopathy. Further work is now needed to formally assess its reliability and validity for potential use in clinical practice and trials. Homeopathy (2012) 101, 28e37.

Objective: To compare acupuncture and placebo for neck pain.

The growth in complementary medicine and its integration into conventional medicine will certainl... more The growth in complementary medicine and its integration into conventional medicine will certainly require the development of a well defined research strategy within the UK. This paper summarizes discussions that occurred under the umbrella of the Foundation for Integrated Medicine, involving both conventional and complementary medical practitioners. It is the first UK-based consensus document that defines a research strategy for complementary and alternative medicine and looks specifically at problems such as priority setting, research methodology, research capacity and support, potential funding streams and possible routes for the dissemination of CAM research. It concludes that for CAM to have an established future within UK healthcare, it must be subject to rigorous scrutiny. The methods employed should be appropriate to the task and should embrace a wide spectrum, both quantitative, qualitative and incorporating projects that involve good practice and audit.

The reasoning behind evaluating medical interventions is that a hierarchy of methods exists which... more The reasoning behind evaluating medical interventions is that a hierarchy of methods exists which successively produce improved and therefore more rigorous evidence based medicine upon which to make clinical decisions. At the foundation of this hierarchy are case studies, retrospective and prospective case series, followed by cohort studies with historical and concomitant non-randomized controls. Open-label randomized controlled studies (RCTs), and finally blinded, placebo-controlled RCTs, which offer most internal validity are considered the most reliable evidence. Rigorous RCTs remove bias. Evidence from RCTs forms the basis of metaanalyses and systematic reviews. This hierarchy, founded on a pharmacological model of therapy, is generalized to other interventions which may be complex and non-pharmacological (healing, acupuncture and surgery).

Background: To explore the strengths and weaknesses of conventional biomedical research strategie... more Background: To explore the strengths and weaknesses of conventional biomedical research strategies and methods as applied to complementary and alternative medicine (CAM), and to suggest a new research framework for assessing these treatment modalities.

Focus on Alternative and Complementary Therapies, 2010

Journal of Alternative and Complementary Medicine - J ALTERN COMPLEMENT MED, 2005

... Harald Walach, Ph.D. Department of Psychology University of Northampton Northampton, United K... more ... Harald Walach, Ph.D. Department of Psychology University of Northampton Northampton, United Kingdom ... Michael Frass, MD Department of Internal Medicine I Medical University of Vienna and Ludwig Boltzmann Institute for Homoeopathy Vienna, Austria ...

Spine, 2004

Study Design. Patients enrolled in a randomized controlled trial were asked to complete various q... more Study Design. Patients enrolled in a randomized controlled trial were asked to complete various questionnaires, which were then compared to establish validity for a new neck pain questionnaire.

QJM, 2006

Background: Osteoarthritis (OA) of the knee is the most prevalent joint disorder. Previous studie... more Background: Osteoarthritis (OA) of the knee is the most prevalent joint disorder. Previous studies suggest that bromelain, a pineapple extract, may be a safer alternative/adjunctive treatment for knee OA than current conventional treatment. Aim: To assess the efficacy of bromelain in treating OA of the knee. Design: Randomized, double-blind placebocontrolled trial. Methods: Subjects (n ¼ 47) with a confirmed diagnosis of moderate to severe knee OA were randomized to 12 weeks of bromelain 800 mg/day or placebo, with a 4-week follow-up. Knee (pain, stiffness and function) and quality-of-life symptoms were reported monthly in the WOMAC and SF36 questionnaires, respectively. Adverse events were also recorded. The primary outcome measure was the change in total WOMAC score from baseline to the end of treatment at week 12. Longitudinal models were used to evaluate outcome. Results: Thirty-one patients completed the trial (14 bromelain, 17 placebo). No statistically significant differences were observed between groups for the primary outcome (coefficient 11.16, p ¼ 0.27, 95%CI À8.86 to 31.18), nor the WOMAC subscales or SF36. Both treatment groups showed clinically relevant improvement in the WOMAC disability subscale only. Adverse events were generally mild in nature. Discussion: This study suggests that bromelain is not efficacious as an adjunctive treatment of moderate to severe OA, but its limitations support the need for a follow-up study.

QJM, 2008

Complementary treatments for osteoarthritis (OA) are sought by patients for symptomatic relief an... more Complementary treatments for osteoarthritis (OA) are sought by patients for symptomatic relief and to avoid the iatrogenic effects of non-steroidal antiinflammatories. This systematic review evaluates the efficacy of the nutritional supplement Perna Canaliculus (green-lipped mussel, GLM) in the treatment of OA and substantially adds to previous work by focussing solely on GLM use in OA as well providing a re-analysis of the original trial data. Randomized or quasi-randomized controlled trials (comparative, placebo-controlled or crossover) were considered for inclusion from Cochrane Library, Medline, Embase, Amed, Cinahl, Scopus and NeLH databases where adults with OA of any joint were randomized to receive either GLM vs. placebo, no additional intervention (usual care), or an active intervention. The methodological quality of the trials was assessed using the JADAD scale. Four RCTs were included, three placebo controlled, the fourth a comparative trial of GLM lipid extract vs. stabilized powder extract. No RCTs comparing GLM to conventional treatment were identified. All four studies assessed GLM as an adjunctive treatment to conventional medication for a clinically relevant time in mild to moderate OA. All trials reported clinical benefits in the GLM treatment group but the findings from two studies cannot be included in this review because of possible un-blinding and inappropriate statistical analysis. The data from the two more rigorous trials, in conjunction with our re-analysis of original data suggests that GLM may be superior to placebo for the treatment of mild to moderate OA. As a credible biological mechanism exists for this treatment, further rigorous investigations are required to assess efficacy and optimal dosage.

Psychotherapy and Psychosomatics, 2010

Psychotherapy and Psychosomatics, 2008

was the primary outcome and Physical Health Component Summary score (PHCS) the secondary outcome.... more was the primary outcome and Physical Health Component Summary score (PHCS) the secondary outcome. Results: This trial population had very low quality of life and symptom scores at entry. There were no differences over 6 months in post-treatment MHCS scores between the treated and untreated groups. There was a non-significant outcome (p = 0.11) for healing with PHCS (1.11; 95% CI -0.255 to 2.473 at 6 months) and a significant effect (p = 0.027) for blinding; patients who were unblinded became worse during the trial (-1.544; 95% CI -2.913 to -0.176). We found no relevant interaction for blinding among treated patients in MHCS and PHCS. Expectation of treatment and duration of CFS added significantly to the model. Conclusions: In patients with CFS, distant healing appears to have no statistically significant effect on mental and physical health but the expectation of improvement did improve outcome.