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Lineas de investigacion en homeopatia_Congreso ESIM/SESMI 2019

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Diaz G. Líneas de investigación en homeopatía: ¿de dónde venimos y adónde vamos? (Oral) En: (SYMPOSIUM) Homeopatía: investigación y estado actual. 12 European Congress of Integrative Medicine. 13-15 September 2019. Barcelone. Spain.

Conferencia sobre lineas de investigacion consolidadas y nuevas lineas de investigacion, en las áreas de plausibilidad biologica (principio activo y mecanismo de accion), eficacia clinica y mejoras metodológicas en la práctica clínica.

Published in: Health & Medicine
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Lineas de investigacion en homeopatia_Congreso ESIM/SESMI 2019

  1. 1. Líneas de investigación en homeopatía: ¿de donde venimos y adonde vamos? Dr. Gualberto Díaz Sáez Asesor Científico de la Asamblea Nacional de Homeopatía (ANH, España)
  2. 2. • Laboratorio: qué es, qué contiene • Laboratorio: mecanismos de acción • Pacientes: ensayo clínico • Pacientes: cohortes • Interés público: epidemiológicos • Interés público: uso y satisfacción • Revisiones: ensayos clínicos • Revisiones: “Fake reports”
  3. 3. Laboratorio: qué es, qué contiene • Termoluminiscencia (Rey), Calorimetría, espectrometría, espectroscopía RAMAN, Resonancia Magnética (Demangeat) Demangeat JL. Nanosized solvent superstructures in ultramolecular aqueous dilutions: twenty years' research using water proton NMR relaxation. Homeopathy. 2013 Apr;102(2):87-105. doi: 10.1016/j.homp.2013.01.001 Nuevas tendencias: • Nanopartículas (Chikramane, Wassenhoven, Indian research) • Tinciones solvatocrómicas (Cartwright) Chikramane PS, Suresh AK, Bellare JR, Kane SG. Extreme homeopathic dilutions retain starting materials: A nanoparticulate perspective. Homeopathy. 2010 Oct;99(4):231-42. doi: 10.1016/j.homp.2010.05.006 Cartwright SJ. Solvatochromic dyes detect the presence of homeopathic potencies. Homeopathy. 2016 Feb;105(1):55-65. doi: 10.1016/j.homp.2015.08.002
  4. 4. Laboratorio: mecanismos de acción • Receptores: histamina, gelsemium • Enzimas: aspirina, arsénico Bellavite P, Bonafini C, Marzotto M. Experimental neuropharmacology of Gelsemium sempervirens: Recent advances and debated issues. J Ayurveda Integr Med. 2018 Jan - Mar;9(1):69-74. doi: 10.1016/j.jaim.2017.01.010 Eizayaga F, Belon P, Desplat V, Aguejouf O, Doutremepuich C. Effects of Ultra-Low-Dose Aspirin in Thrombosis and Haemorrhage. Homeopathy. 2019 Apr 20. doi: 10.1055/s-0038-1677495 Nuevas tendencias: • Expresión genómica (Bellavite) • Expresión proteómica (Meneses) Dei A, Bernardini S. Hormetic effects of extremely diluted solutions on gene expression. Homeopathy. 2015 Apr;104(2):116-22. doi: 10.1016/j.homp.2015.02.008 https://www.hablandodehomeopatia.com/entrevista-niurka-meneses-investigadora-ciencias-biomedicas-especialista- agrohomeopatia/
  5. 5. Pacientes: ensayo clínico • Diseño clásico • Oportunista Frass M. Influence of potassium dichromate on tracheal secretions in critically ill patients. Chest. 2005 Mar;127(3):936-41 Macías-Cortés Edel C. Individualized homeopathic treatment and fluoxetine for moderate to severe depression in peri- and postmenopausal women (HOMDEP-MENOP study): a randomized, double-dummy, double-blind, placebo-controlled trial. PLoS One. 2015 Mar 13;10(3):e0118440. Nuevas tendencias: • Ensayo pragmático, sobre cohortes (cmRCT, TwiCs) • Estratégico (infecciones, mujer, soporte oncológico, sobremedicalización) Viksveen P, Relton C, Nicholl J. Benefits and challenges of using the cohort multiple randomised controlled trial design for testing an intervention for depression. Trials. 2017 Jul 6;18(1):308. doi: 10.1186/s13063-017-2059-4 Fibert P, Peasgood T, Relton C. Rethinking ADHD intervention trials: feasibility testing of two treatments and a methodology. Eur J Pediatr. 2019 Jul;178(7):983-993. doi: 10.1007/s00431-019-03374-z
  6. 6. Pacientes: cohortes • Monocéntricos • Escalas limitadas Nuevas tendencias: • Multicéntricos • Escalas adaptadas  Epidemiológicos
  7. 7. Interés público: epidemiológicos • EPI3 Francia (pubmed: epi3+duru) – https://www.ncbi.nlm.nih.gov/pubmed/?term=epi3+duru (PubMed: epi3+duru) • Hospitales homeopáticos de UK – Spence DS, Thompson EA, Barron SJ. Homeopathic treatment for chronic disease: a 6-year, university-hospital outpatient observational study. J Altern Complement Med. 2005 Oct;11(5):793-8. – Sharples FM, van Haselen R, Fisher P. NHS patients' perspective on complementary medicine: a survey. Complement Ther Med. 2003 Dec;11(4):243-8. • Aseguradoras Alemania – Witt CM, Lüdtke R, Mengler N, Willich SN. How healthy are chronically ill patients after eight years of homeopathic treatment?-- Results from a long term observational study. BMC Public Health. 2008 Dec 17;8:413. doi: 10.1186/1471-2458-8-413. • Experiencia Toscana – Rossi E, Di Stefano M, Picchi M, Panozzo MA, Noberasco C, Nurra L, Baccetti S. Integration of Homeopathy and Complementary Medicine in the Tuscan Public Health System and the Experience of the Homeopathic Clinic of the Lucca Hospital. Homeopathy. 2018 May;107(2):90-98. doi: 10.1055/s-0038-1636839 ¿Valor y repercusión? ¿Interés de medir las prácticas mixtas (MI)? ¿Interpretación?
  8. 8. Interés público: uso y satisfacción • General • Monocéntrico Nuevas tendencias: • Por patología • Por forma de uso (autocuidado, prescripción) • Multicéntrico Rhee TG, Ng JY, Dusek JA. Utilization and perceived benefits of homeopathy and herbal therapies in U.S. adults: Implications of patient-centered care. Complement Ther Clin Pract. 2017 Nov;29:9-15. doi: 10.1016/j.ctcp.2017.07.003
  9. 9. Revisiones: ensayos clínicos • Globales • Polarizadas (escépticos / defensores) Nuevas tendencias: • Por patología • Por tipo de homeopatía (Individualizada / No-Ind) • Agencias: Revisión de revisiones National Health and Medical Research Council. 2015. NHMRC Information Paper: Evidence on the effectiveness of homeopathy for treating health conditions. Canberra: National Health and Medical Research Council; 2015 EASAC Working Group. Homeopathic products and practices: assessing the evidence and ensuring consistency in regulating medical claims in the EU. EASAC; 2017
  10. 10. Revisiones: “Fake reports” • Artículos de revista: impacto en el sector • Artículo Shang: impacto mediático – análisis metodológico, reanálisis publicado • Informe Science&Technology Committee: impacto político (fuera de UK) – Acción de lobby suficiente en el Parlamento pero no en los medios • Informe Australiano: repercusión global – análisis metodológico + buenas prácticas en los procedimientos + impacto político y social • Posverdad en los medios: Fake news – noticia a noticia: El País – muertes x4 https://www.hri-research.org/resources/homeopathy-the-debate/ https://www.homeopatiasuma.com/desmontando-fake-news/
  11. 11. Mejorar la práctica clínica • Casos Clínicos  Guías de calidad van Haselen RA. Homeopathic clinical case reports: Development of a supplement (HOM-CASE) to the CARE clinical case reporting guideline. Complement Ther Med. 2016 Apr;25:78-85. doi: 10.1016/j.ctim.2015.12.019 Herramienta: https://care-writer.com/ • Series de casos  Plataformas digitales CLIFICOL: https://www.clificol.net/project)
  12. 12. Mejorar la práctica clínica • Materias Médicas (Vademécum)  Estimación de la probabilidad de respuesta a un medicamento y depuración de Materia Médica (Likehood Ratio) Eizayaga JE, Pozzi MI, Canan MC, Saravia L. Prevalence and likelihood ratio of symptoms in patients with good therapeutic response to Lycopodium clavatum. A retrospective study. Homeopathy. 2016 Feb;105(1):78-83. doi: 10.1016/j.homp.2015.09.002 • Reflexión clínica   Análisis de sesgos cognitivos Lex Rutten. Fundamentals of Statistics & Clincial Research in Homeopathy. B Jain Publishers Pvt Ltd (30 de agosto de 2018)  Aplicación de la probabilística Bayesiana Miglani A, Rutten L, Manchanda RK. Generalisability of prognostic factor research: further analysis of data from the IIPCOS2 study. Homeopathy. 2017 Aug;106(3):155-159. doi: 10.1016/j.homp.2017.06.001
  13. 13. Líneas de investigación en homeopatía: ¿de donde venimos y adonde vamos? Dr. Gualberto Díaz Sáez, Responsable de investigación de la ANH
  14. 14. Resumen • La presentación expone una breve revisión de los avances en la investigación en homeopatía a diferentes niveles y de las perspectivas de futuro que se abren. • Las evidencias que ya conocemos nos permiten ser contundentes a la hora de establecer que los medicamentos homeopáticos tienen efectos biológicos específicos, que la aplicación clínica de la homeopatía produce resultados clínicos que además pueden ser relevantes en salud pública. • Los nuevos diseños y líneas de investigación nos permitirán discriminar diferentes principios activos homeopáticos entre sí (lo que permitirá mejores controles de calidad), definir mejor los mecanismos de acción de los medicamentos homeopáticos, demostrar efectividad en condiciones reales y para los problemas de salud más relevantes, y también mejorar la metodología de consulta homeopática así como los datos relativos a cada medicamento. Palabras clave: Investigación, homeopatía, revisión, metodología
  15. 15. Abstract • The objective is to present a brief review of the advances made in research at different levels regarding homeopathy, and the perspective opened for the future research and knowledge. • The evidence that we already know allow us to be forceful when it comes to stating that homeopathic medicines have specific biological effects, that it clinical application can produce clinical positive results which can additionally be relevant for public health. • New research designs and research lines will allow us discriminate between different homeopathic active principles (which will allow better quality controls), define better the mechanisms of action, prove effectivity under real life conditions and for the most relevant health problems and also improve the methods for the homeopathic consultation and the data of each medicine. Key words: research, homeopathy, review, methods

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