Monday, November 28, 2011

Chinese medicine could double the chances of childless couples conceiving (?)

It is perfectly reasonable to believe that in the course of a very old civilization, herbal discoveries may have been made and passed on which have a genuine therapeutic benefit. After all, to this day a large part of the pharmacopeia is of herbal origin. And there are many places where Chinese herbalists enjoy considerable acceptance. Where I grew up, if you were sick, you went to the doctor. But if you were REALLY sick you went to the Chinese herbalist.

And I myself seem to have had some benefit from it. When I got glandular fever many years ago and the doctors told me that there was nothing they could do for it, my course of action was clear. I promptly went to a Chinese herbalist, took his preparations and was better within a week!

Anecdotes prove nothing of course but I mention that one to show that I was disposed to accept the findings below. I am afraid, however that I have to offer the old Scottish verdict of "Not Proven".

Meta-analyses are very hard to critique unless you either know the relevant literature very well or re-do the whole meta-analysis yourself. And if you do know well the literature that is analysed you can get a considerable shock at how badly such an analysis can be done -- even analyses reported in the most prestigious journals. I comment on one such analysis in my own research field here. The problem is particularly bad where there is a barrow to be pushed and "complementary" medicine is of course a very large barrow indeed.

My suspicions are aroused by the very large discrepancy reported between the effects of Chinese and Western medicine. It is a characteristic of quackery to claim exaggerated benefits and it seems to me that the endless search for new molecules carried out by drug companies would long ago have gone through anything as effective as that with a fine-toothed comb.

So in the end it gets back to what was meta-analysed. It seems to me that the people most likely to have done the sort of study described below would be enthusiasts for alternative therapies and we all know how large the effect of experimenter expectations can be. Just one good double-blind study from someone skeptical of Chinese medicine would be more persuasive.

I include the journal Abstract below

Couples with fertility problems are twice as likely to get pregnant using traditional Chinese medicine as western drugs, say researchers. They found a two-fold improvement in pregnancy rates over just four months of treatment from practitioners of traditional Chinese medicine.

At least six million Britons have consulted a Western or traditional Chinese herbal practitioner in the last two years, according to Ipsos Mori research. Previous research suggests acupuncture may help some childless couples to conceive.

The latest study from researchers at Adelaide University, Australia, reviewed eight clinical trials, 13 other studies and case reports comparing the efficacy of traditional Chinese medicine (TCM) with western drugs or IVF treatment.

The review funded by the Australian government included 1,851 women with infertility problems, says a report in the journal Complementary Therapies in Medicine.

Review of the clinical trials alone found a 3.5 rise in pregnancies over a four-month period among women using TCM compared with western medicine.

Other data covering 616 women within the review showed 50 per cent of women having TCM got pregnant compared with 30 per cent of those receiving IVF treatment.

The overall analysis concluded there was a two-fold increase in the likelihood of getting pregnant in a four-month period for women using TCM compared with orthodox approaches.

The study’s authors said ‘Our meta-analysis suggests traditional Chinese herbal medicine to be more effective in the treatment of female infertility - achieving on average a 60 per cent pregnancy rate over four months compared with 30 per cent achieved with standard western drug treatment.’

The study said the difference appeared to be due to the careful analysis of the menstrual cycle – the period when it is possible for a woman to conceive – by TCM practitioners.

It said ‘Assessment of the quality of the menstrual cycle integral to TCM diagnosis appears to be fundamental to the successful treatment of female infertility.’

Dr Karin Ried (correct) of the university’s school of population health and clinical practice, who led the study, said infertility affects one in six couples and even after investigations 20 per cent of infertility remains ‘unexplained’.

She said TCM recognises many more ‘menstrual disturbances’ than conventional medicine, is far less expensive than IVF treatment and less stressful.

Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: A systematic review

By Karin Ried & Keren Stuart

To assess the effect of Traditional Chinese Herbal Medicine (CHM) in the management of female infertility and on pregnancy rates compared with Western Medical (WM) treatment.

We searched the Medline and Cochrane databases and Google Scholar until February 2010 for abstracts in English of studies investigating infertility, menstrual health and Traditional Chinese Medicine (TCM). We undertook meta-analyses of (non-)randomised controlled trials (RCTs) or cohort studies, and compared clinical pregnancy rates achieved with CHM versus WM drug treatment or in vitro fertilisation (IVF). In addition, we collated common TCM pattern diagnosis in infertility in relation to the quality of the menstrual cycle and associated symptoms.

Eight RCTs, 13 cohort studies, 3 case series and 6 case studies involving 1851 women with infertility were included in the systematic review. Meta-analysis of RCTs suggested a 3.5 greater likelihood of achieving a pregnancy with CHM therapy over a 4-month period compared with WM drug therapy alone (odds ratio = 3.5, 95% CI: 2.3, 5.2, p < 0.0001, n = 1005). Mean (SD) pregnancy rates were 60 ± 12.5% for CHM compared with 32 ± 10% using WM drug therapy. Meta-analysis of selected cohort studies (n = 616 women) suggested a mean clinical pregnancy rate of 50% using CHM compared with IVF (30%) (p < 0.0001).

Our review suggests that management of female infertility with Chinese Herbal Medicine can improve pregnancy rates 2-fold within a 4 month period compared with Western Medical fertility drug therapy or IVF. Assessment of the quality of the menstrual cycle, integral to TCM diagnosis, appears to be fundamental to successful treatment of female infertility.


Daily aspirin is 'not worth the risk' for healthy middle-aged women

Aspirin is a bad bargain for healthy women trying to stave off heart attacks or strokes, according to Dutch researchers.

They said 50 women would need to take the medication for 10 years for just one to be helped - assuming they are all at high risk to begin with.

'There are very few women who actually benefit,' said Dr Jannick Dorresteijn of University Medical Center Utrecht in The Netherlands. 'If you don’t want to treat 49 patients for nothing to benefit one, you shouldn’t treat anyone with aspirin.'

The new study adds to a long-standing controversy over aspirin, one of the world’s most widely used drugs. Common side-effects include irritation of the stomach or bowel, heart burn and nausea.

Doctors agree it’s worth taking for people who’ve already had a heart attack or a stroke, but they are less certain when it comes to so-called primary prevention.

'We all appreciate that the average treatment effect is very small, but that some patients may benefit more than others,' Dr Dorresteijn said.

Today, leading medical groups like the American Heart Association recommend aspirin for people at increased risk for heart problems.

But the Dutch findings, published in the European Heart Journal, suggest many women would still be taking the drug needlessly.

The team analysed data from nearly 28,000 healthy women aged 45 and above who had received either aspirin or dummy pills in an earlier U.S. trial. The women on aspirin generally took a low dose of 100mg every other day.

Overall, aspirin cut the rate of heart attacks, strokes and death from heart disease from 2.4 per cent to 2.2 per cent.

'Nine out of 10 women experience less than a one-percent risk reduction for cardiovascular disease in the next ten years, so that is a really small treatment effect,' Dr Dorresteijn said.

He added that aspirin comes with side effects, too. For instance, it can cause bleeding ulcers and make people more likely to bruise due to its blood-thinning effects.

And although it’s cheap - at only a few pounds per month of treatment - putting lots of healthy people on the drug would be a big expenditure.

After subtracting the serious side effects from the health gains, the Dutch team found doctors would have to be willing to treat a lot of women to get a net advantage.

'Women older than 65 years of age benefit more than average, but still for those women the benefit was so small that you would need to treat 49 for nothing to prevent one event,' said Dr Dorresteijn. “of course it’s disappointing, because you would like a medication to be effective.'

Earlier this year, two large reviews of previous aspirin trials yielded similarly sobering results. One found a tiny reduction in heart attacks with aspirin and no effect on death rates or strokes. The other showed as many as 1,111 men and women would need to take aspirin daily for the duration of the trials to prevent just one death.

In the UK low-dose aspirin (75mg) is often prescribed after a heart attack, stroke, or coronary bypass operation. It may also be given to patients with high blood pressure and long-term diabetes sufferers.

Dr Michael LeFevre of the U.S Preventive Services Task Force said the latest findings muddied the potential benefit on stroke by including heart attacks in the analysis.

'The central message of this study is really that there are an awful lot of women who are taking aspirin for prevention who should not be taking aspirin,' he said.

Dr. Franz Messerli, who heads the high blood pressure program at St. Luke’s-Roosevelt Hospital in New York, said there are much better ways to curb stroke risk than taking aspirin. 'First and foremost make sure your blood pressure is perfectly well-controlled… because blood pressure is by far the most important risk factor for stroke.'

That can be achieved by changing diet and exercise habits, or by blood pressure medications like diuretics, beta-blockers or calcium channel blockers.


No comments: