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Homeopathy shows some promise in AOM. (Obstacles to Study This Therapy Remain).

Do you feel pressured by parents to "do something" for the child clearly hurting with acute otitis media?

Are you conscious of the negative public health implications of routinely prescribing antibiotics for a condition that in most cases will resolve spontaneously?

"There now is a viable alternative to antibiotics in the initial treatment of uncomplicated acute otitis media, Dr. Jennifer Jacobs of the University of Washington, Seattle, said in an interview.

There is a treatment that will reduce pain and fever, thereby giving doctors "something to do" for symptomatic relief while they are waiting for the patient's body to heal itself-homeopathy.

This highly controversial practice is a 200-year-old system of medicine founded by German physician Samuel Hahnemann, who believed that many of the conventional medical practices of the day, such as purging and bloodletting, were unduly harsh.

Dr. Hahnemann developed the concept of "like cures like" that involves the administration of minute doses of a substance, which in a large quantity would cause the same symptoms.

Also central to Dr. Hahnemann's system was the practice of "provings," in which his materia medica was subjected to successive dilutions that resulted in a final remedy so dilute that none of the original molecules of the substance were likely to remain.

Dismissed as scientifically preposterous and its supposed effects considered placebo by conventional medicine--at least in the United States--homeopathy has been gaining in popularity and has become a focus of scientific analysis in recent years. Several controlled studies have found clear differences between homeopathic remedies and placebo treatment.

One of these studies, published recently by Dr. Jacobs and her colleagues, was a randomized, double-blind, placebo-controlled pilot study comparing individualized homeopathic remedies with placebo in 75 children with acute otitis media (Pediatr. Infect. Dis.J. 20[2]:177-83, 2001).

The study subjects ranged in age from 18 months to 6 years.

The children were treated with an individualized homeopathic medicine, such as pulsatilla (from windflower) and chamomilla (from German chamomile) or received placebo for 5 days or until symptoms of acute otitis media subsided.

Treatment failure was defined as ear pain and/or a fever of greater than 380[degrees]C at any time after 48 hours of treatment, severe ear pain with crying, and/or a fever greater than 390[degrees]C after the first 24 hours.

There were 7 treatment failures in the homeopathy group and 12 in the placebo group, a difference that was not statistically significant.

Decreases in symptom scores, however, significantly favored homeopathy after 24 and 64 hours of treatment.

Noting that their findings were preliminary ,the investigators concluded, "These results suggest that a positive treatment effect of homeopathy when compared with placebo in uncomplicated [acute otitis media] cannot he excluded and that a larger study is justified."

But obstacles remain. Homeopathy by its very nature is exceedingly difficult--some would say impossible--to evaluate in randomized studies, because in real-world practice treatment is highly individualized.

In Dr. Jacob's study for example, eight duff rent remedies were used, chosen according to the individual patient's symptom pro ile.

This is, of course, quite unlike the approach used in the evaluation of conventional drug therapy where a single substance is tested in a large number of patients.

Homeopathic treatments also are typical y based on lengthy personal interviews with the patient, and the influence this patient-clinician-intensive relationship has for overall treatment success has not been clarified.

According to Dr. Jacobs, the most significant difficulty faced by researchers interested in homeopathy is funding.

"There are no huge profits to be made from homeopathic medicines [because] the are generic and cannot be patented," she aid, noting that upwards of $1 million would be needed for a study that would be large enough for firm conclusions to be drawn.

She has applied to the National Institutes of Health for funding for a larger study of homeopathic treatment for acute otitis media, which she plans to do in ccllaboration with a team of pediatric otolaryngologists.
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Title Annotation:acute otitis media
Author:Walsh, Nancy
Publication:Pediatric News
Article Type:Brief Article
Geographic Code:1USA
Date:Jan 1, 2002
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